The BMJ Podcast: Recent Episodes

BMJ Group

The BMJ is an international peer reviewed medical journal and a fully “online first” publication. The BMJ’s vision is to be the world’s most influential and widely read medical journal. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. We aim to help doctors to make better decisions.

This week we focus on the external forces that shape medicine and healthcare.

Global health is changing, after the reduction in financing from wealthy nations, the global community are beginning to implement reforms to improve the situation. However, any change will be unsuccessful until we tackle the fundamental structures that govern outcomes, argue Daniel Bernal-Serrano and Omar Gabriel Torres Valencia from the London School of Hygiene and Tropical Medicine. They join us to explain how economic forces, wealth distribution, and market dynamics undermine health outcomes.

We also learn about the rapid rise in private equity financing of healthcare in the UK, and the dangers that poses to healthcare quality. Bernd Rechel is a researcher at the European Observatory on Health Systems and Policies, and explains how different countries are handling this drive for healthcare profit extraction.

Reading list:

Private equity involvement in UK healthcare
Reforming global health architecture requires confronting its political economy

In this week's podcast - the Sensitivity of Patient Questionnaires: If you've ever asked a patient to fill out a Patient Health Questionnaire (like the PHQ-9) to assess their mental health and wondered exactly how much of a change it can actually detect, new research just published on bmj.com sets out to answer that question. We're joined by Brett Thombs, Professor in the department of Psychiatry at McGill University

Also this week, Are Doctors Scared of Death? BMJ Careers Editor Abi Rimmer sits down in the studio with Richard Coker, Emeritus Professor of Public Health at LSHTM. Drawing from his early days as an HIV doctor during the onset of the AIDS epidemic, and later with infectious disease outbreaks in South East Asia. Professor Coker discusses the profound experiences of the end of his patients lives that shaped his new book, Timor Mortis: How We Live with Death.

Reading list:

Minimal detectable change of the Patient Health Questionnaire-9, Patient Health Questionnaire-8, and Patient Health Questionnaire-2`

Known for his use of devolved powers, during his tenure as Mayor of Greater Manchester, Andy Burnham now has the opportunity to bring his local blueprint to the national stage. But what does this mean for the future of health and social care?

Our panel explore the deeply rooted health inequalities tied to the social determinants of health, the disconnect between local decision-making and national infrastructure, and the urgent need to extend the ability to access social care to more of England's population.

We're joined by

Michael Marmot: Professor of Epidemiology and Public Health at University College London (UCL) and author of the landmark Marmot Review.
Sarah Woolnough: Chief Executive of the health think tank, The King's Fund.
Matt Sutton: Professor of Health Economics at the University of Manchester.

Reading List* Devolution can create new opportunities forbetter health * Will devolving powers to mayors close England’s health gap? * Andy Burnham’s goal of good growth could be a health-creating mission that supports environmental action * The King's Fund responds to Andy Burnham’s comments on social care

Discrimination in NHS Hiring: We examine the troubling success rates of Black and Asian doctors when applying for NHS jobs. Deputy news editor, Gareth Iacobucci speaks to Anthony Emmanushares his analysis on why discrimination persists in the medical workforce and what recent reports reveal.

The Ethnicity Data Gap in Research: While sex and gender are reported in 99% of trials, ethnicity is reported in only 48%. Bianca Brijnath, Professor of Health Communication in Society at La Trobe University, joins us to discuss a newly published framework aimed at standardizing the capture and reporting of ethnicity data in clinical trials.

The Evidence Revolution: We celebrate how evidence-based medicine (EBM) has set the gold standard for other areas of science. Mun-Keat Looi, The BMJ’s International News and Features Editor, speaks with Nature editor and science journalist Helen Pearson about her new book, Beyond Belief: How Evidence Shows What Really Works.

Reading ListBlack and Asian doctors are up to 30 times less likely to be offered medical training posts in some specialties, data show

Measurement of ethnicity in clinical trials: Delphi survey and consensus statement

Beyond Belief: How Evidence Shows What Really Works by Helen Pearson

Who actually owns our health data once it is stored in the cloud? And how do we balance the global push for open medical research with the need to protect local populations from data extraction?Kamran Abbasi sits down with Trudie Lang, Professor of Global Health Research at the University of Oxford and David Strain, Associate Professor of Cardiometabolic Health at the University of Exeter.Together, they dive into the complex ethical and legal landscape of data sovereignty - unpacking the loopholes that could allow the US government access to NHS data, and how medical research in resource poorer settings can be extractive of data. They set out the case for data sovereignty, and how it could practically work while not stifling essential international research collaborationRead the related articles on BMJ.com:The CLOUD Act: NHS data must be safeguarded from US interests by David StrainA commitment to act on data sharing by Kamran AbbasiData sharing must evolve towards data sovereignty by Trudie Lang

Two NHS maternity reviews have been published over the past few weeks. The biggest ever conducted, involving nearly 2500 families, investigated services at Nottingham university hospitals NHS trust. It was led by senior midwife, Donna Ockenden, and its findings on poor and avoidable harm to babies and mothers have reverberated throughout UK healthcare.

This was followed immediately by publication of an independent investigation into maternity and neonatal services in England, conducted by Valerie Amos, which states that the UK's poor maternity care is "on a scale that shames our society".

We speak to Kate Duhig, clinical senior lecturer at Kings College London, and Marian Knight, professor of of maternal and child population health at the University of Oxford, about why we keep having reports saying the same thing, but little action to solve the problem.

As many wealthy nations have stepped back from previous aid promises, a new force has emerged to fill the gaps: private finance. David McCoy is professor of global public health at the United Nations University, and explains why turning to investment banks, wealth funds, and private equity in the pursuit of universal health coverage might cause more problems than it solves.

Reading list:

Dangers of finance capital in healthcare

Amos maternity review: Doctors must work differently as units “no longer fit for purpose,” but report is dogged by controversy

Nottingham maternity review: 520 mothers and babies were seriously harmed on “toxic” ward, damning inquiry finds

Australia has been in the vanguard of legislation to try and reduce the influence of social media on children and young people - their ban for under 16s was introduced on the 10th of December 2025, to great fanfare, and a lot of interest around the world.

But how effective are these bans at keeping children away from social media?

New research just published on BMJ.com has looked at that question of efficacy - finding that children are using the most simple tactics to evade the ban.

To dicuss what that means, we're joined by two of the authors of that research Courtney Barnes and Luke Wolfenden from the University of Newcastle, Australia.

We’re also joined by Amrit Purba, from the London School of Hygiene and Tropical Medicine, and Louise Holly, from the Digital Transformations for Health Lab, in Geneva, who have written commentaries to go with that research.

Reading list

Assessing early effects of Australia’s Social Media Minimum Age Act on adolescents’ social media use

Learning from Australia’s social media age restriction policy

Early data from Australia indicate that social media companies can’t be relied on to protect children

The US military’s Operation “Epic Fury” highlighted the devastating cost of using artificial intelligence for rapid military planning. Thomas Adamkiewicz, associate professor at Morehouse School of Medicine, and Zulfiqar Bhutta, Robert Harding Inaugural Chair in Global Child Health at the Hospital for Sick Children, Toronto, to discuss why international humanitarian law is lagging dangerously behind technology, and why we urgently need a new era of legal frameworks to govern AI use in war.

Direct-to-consumer (DTC) advertising of prescription medicines is strictly illegal everywhere in the world except for the United States and New Zealand. Deborah Cohen, investigative journalist, joins us to explain how global social media platforms are making borders porous, allowing Hollywood celebrities and high-profile influencers to broadcast drug endorsements directly into the feeds of UK citizens.

Finally, Between 2020 and 2023, the UK government allocated £1.7 billion specifically intended for frontline doctor training. However, a deep-dive investigation has revealed that a staggering £400 million of that funding is completely unaccounted for - David Hutchison, paediatrics registrar, and Jonathan De Oliveira, GP trainee, join us to describe what they found.

Reading List* AI warfare demands a new era of humanitarian law * Bad influencers: How social media imported US-style drug advertising to the UK * “Black hole” of medical student funding

The heated debate on prostate cancer screening boils down to one question: should men be routinely screened?

Two recent position statements from the UK’s national screening committee published in the BMJ show that screening decisions are steeped in complexity.

The benefits of screening may be easier to grasp, but the harms of overdiagnosis and overtreatment are given less attention. Can we close the divide between the public and academic discourse?

Guest: Sian Taylor-Phillips is professor of population health at the University of Warwick and a member of the UK national screening committee.

Further Reading:

UK National Screening Committee position statement on surrogate outcomes in cancer screening trials
Prostate cancer screening: Committee rejects calls for mass testing programme despite pressure

More interviews from the BMJ on our Youtube channel.

New estimates of Global Patterns in Neonatal, Child, and Adolescent Mortality have been published - and while there has been a huge improvement, those gains are in danger - and we’re seeing worrying trends.

Kate Strong, a Scientist at the World Health Organization and Lucia Hug, a specialist in statistics and monitoring for UNICEF, join us to explain the data - and why they are worried about our ability to measure this in the future.

Helen Sharman is the first British Astronaut to make it to space - this week she was at the Royal College of GPs giving the General Medical Council's annual Marx lecture. She joins us to discuss how research in space might impact healthcare on Earth, and what the NHS can learn from cosmonaut teamwork.

Finally, The government and doctors in England are not getting on well - we’ve had a series of strikes from the resident doctors, GPs are in dispute about the imposition of a new contract, and now consultants are being polled on industrial action. BMA Consultants Committee co-chairs Shanu Dutta and Helen Neary explain why.

Reading list

Neonatal, Child, and Adolescent Mortality

Global, regional, and national levels and trends in under 5, infant, and neonatal mortality during 1990-2024 with scenario based projections to 2030

Global, regional, and national levels and trends in older child, adolescent, and youth (5-24 years) all cause mortality from 1990 to 2024: modelling study

Systematic estimates of global causes of neonatal and under 5 mortality in 2000-24: secondary data analysis using bayesian multinomial logistic regression

Estimates of global causes of death for children and adolescents aged 5-19 in 2000-24: secondary data analysis using bayesian multinomial logistic regression

Full interview on YouTube:

Why NHS Senior Doctors in England Are Considering Strike Action

Does healthcare have a moral emergency?

In this episode of the Medicine and Science podcast, Kamran Abbasi sits down with healthcare leaders Maureen Bisognano, president emerita of the Institute for Healthcare Improvement and Bob Klaber, director of strategy at Imperial College Healthcare NHS Trust, to discuss why they're calling the lack of humanity in medicine an emergency.

We ask why this dangerous imbalance between the rational (efficiency, data, and metrics) and the relational (human connection, empathy, and listening) has developed in modern medicine. We also learn how simple changes, like asking "What matters to you?" instead of just "What's the matter?, can help us put the humanity back into healthcare.

Reading list

Read the BMJ Article: Healthcare's moral emergency: reconnecting healthcare with its mission and purpose

Michael West on workforce kindness

Amy Edmondson on psychological safety

Len Berry on cancer care & kindness

It has been a tumultuous time in UK health politics. UK Health Minister ,Wes Streeting, has freshly resigned. What does this mean for his newly introduced NHS Modernization Bill as it heads through Parliament?

Together with Hugh Alderwick, Director of Policy and Research at the Health Foundation, we unpack the bill's sweeping centralization of power, the abolition of NHS England, and the contentious role for US tech firm Palantir in the new NHS.

And, we explore a major milestone for women's healthcare. A condition affecting an estimated 170 million women globally has officially been renamed from Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS). Rachel Morman, Chair of the PMOS charity Verity, joins us to explain why dropping "cysts" from the name is a vital step toward recognizing this as a complex, multi-system condition, and how this co-designed change will fundamentally reshape diagnosis, treatment, and future research.

Further reading:

Health Bill brings NHS management back into government

PMOS: What's in a name? Everything

PCOS name change to PMOS must be managed to avoid confusing patients, says expert

Twitter was launched 20 years ago, followed quickly by the iPhone and Instagram. Today, nearly 60% of the world’s population uses social media. Medical experts are sounding the alarm on the potential for these platforms to cause systemic harm. This past year has seen large events in the legal and public health battle against tech giants, with millions of dollars awarded in damages to child victims. Why has pinning down these companies proven difficult? And, what are the parallels between the social media industry and the historical tactics of "Big Tobacco"?

Guests:

Matthew Bergman is a practicing attorney and the founder of the Social Media Victims Law Center, as well as a professor at Lewis & Clark Law School in Portland, Oregon.

Ilona Kickbusch is an editorial board member of the BMJ and a visiting professor at the Digital Transformations for Health Lab at the University of Geneva, specializing in the commercial determinants of health.

Further reading:

From tobacco to TikTok: what public health litigation history tells us about holding social media accountable

What is the evidence for social media addiction?

The BMA has released their long awaited review of the Cass report. The original report looked at the provision of NHS gender identity services for children and young people, and involved a review of the science underpinning those services. It also set out a plan to improve care for gender diverse young people.

We talk with David Strain of the BMA’s board of science to discuss their findings, and hear why they were critical of the Secretary of State, Wes Streeting's response to Cass’s review.

And, we hear about new research published with The BMJ that aims to help children with autism. The researchers used a non-invasive magnetic stimulation technique to target specific regions of the brain, with the goal of promoting sociality. We discuss the benefits, and how this technique might translate to treatment plans for patients.

Guests:

David Strain is an associate professor in cardio-metabolic health at the University of Exeter and Chair of the BMA’s Board of Science.

Benjamin Becker is a professor of psychology and neuroscience at the University of Hong Kong, specializing in brain-based interventions for mental disorders.

Further reading:

Puberty blockers: BMA critique vindicates Cass review but questions government “overreach”

Accelerated non-invasive brain stimulation in childhood autism

The new trade deal struck between the UK and US came into force in April.

The deal will

double the amount that the NHS spends on new medicines, by the end of 2036 (from 0.6 - 0.6% of GDP).
increase the threshold that the National Institute for Health and Care Excellence (NICE) sets for drug approvals - which will allow more to be approved, but will also allow companies to charge more for their pharmaceuticals,
include a change to the rebate the NHS receives, to ensure that the extra drug spend occurs.

Cumulatively this will increase our drug spend by £56 billion in the next 10 years, which will have to come out of current healthcare spending - which experts are calling a catastrophe for the NHS.

Joining Kamran Abbasi to discuss are Sally Gainsbury, a senior policy analyst Nuffield Trust and Karl Claxton, professor of economics at the University of York. We also hear from Francis Ruiz, policy analyst at the London School of Hygiene and Tropical Medicine.

Reading list

The UK government must publish a detailed impact assessment of the costs and benefits of the US-UK medicines partnership

A budget apart: the case for ringfencing medicines in the UK

A blockbuster MS drug undergoes FDA re-evaluation. We explore the story of Ocrelizumab, a treatment for primary progressive multiple sclerosis, following a patient petition that highlighted internal disagreements among agency reviewers regarding its efficacy.

We look to Sweden, where new research involving sibling pairs separated by adoption investigates how early-life environments shape long-term health and social outcomes.

Finally, we revisit the dominant medical narrative on Alzheimer’s disease. Why is it so difficult to move towards comprehensive treatments? Has the focus on amyloid plaques hindered our understanding of other critical factors like vascular health and social inequality?

Peter Doshi is a senior editor at The BMJ and an associate professor of pharmaceutical health services research at the University of Maryland.

Erik Peterson is an associate professor at the Karolinska Institute in Stockholm, specializing in psychiatric epidemiology and adoption studies.

Carol Brayne is a professor emerita of public health medicine at the University of Cambridge and a leading expert in the epidemiology of dementia.

Reading List:

Multiple sclerosis: Could Roche's bestselling drug Ocrevus be doing more harm than good in women with primary progressive MS?

Home environment conditions during childhood and psychosocial outcomes across three generations in Sweden: population based adoption-discordant sibling comparison study

Covid 19 was the last Public Health Emergency of International Concern (PHEIC). Our guests in this podcast think that the Trump Administration should be declared the next one.

Joining Kamran Abbasi are, Fatima Hassan, human rights lawyer and Director of the Health Justice Initiative in South Africa, and Matthew Herder, Director of the Health Justice Institute at Dalhousie University in Canada explain why they think that the actions and consequences of the Whitehouse meet the bar for WHO to delcare an emergency

We examine the global consequences of recent US policy shifts, including:

The withdrawal from the World Health Organization (WHO) and its implications for international health governance.
Significant funding cuts to global health programs, including PEPFAR and the CDC, and how these disruptions affect life-saving HIV and TB treatments in the Global South.
The rise of "unhinged nationalism" in health policy, from North American measles outbreaks to the extraction of trade concessions in exchange for medical aid.
The role of US health leadership in fueling vaccine hesitancy and dismantling scientific research at the NIH.

Reading list:

Trump and his administration as a public health emergency of international concern
Why the expanded global gag rule is a deadly triple tripwire for recipients of US foreign aid
The power of the markets: the scandal that keeps on taking

Coming up in this week’s episode:

The 15th Strike: As the latest six-day walkout by resident doctors in England concludes, the BMJ's news team examines the state of the ongoing dispute over pay and training places.

Iain Beardsell, consultant in emergency medicine in Southampton explain why he thinks reintroducing compassion could be the key to tackling the systemic issues facing emergency departments

And finally, The BMA announces major changes to how it represents doctors in private practice - we hear why they think the US has some better legislation around health insurance than the UK.

Reading list:

Resident doctor strikes: Streeting demands to “meet with the organ grinders” as latest action ends
The BMJ interviews Jack Fletcher
Make compassion visible in emergency medicine again
BMA boosts support for private practice as NHS failings prompt more patients to pay for care

The BMJ published a negative result this week. A new trial focuses on a peer support intervention for improving breastfeeding rates in the UK, but finds no major improvement. We hear from the lead author who tells us what went wrong, and the insights that can still be drawn from apparent ‘failures’.

Next we turn our eyes to shisha smoking in the UK. With shisha or “hookah” cafes on the rise, we explore the smoking habit in more detail. What are the effects on health? And why are UK laws poor at regulating the practice?

Kate Jolly is professor of public health and primary care at the University of Birmingham.

Zainab Hussain is a UK-based freelance journalist writing on behalf of The BMJ.

Links:

Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial
Shisha tobacco’s availability is rising. Why does UK smoking policy fail to tackle it?

The UK Covid Inquiry released Module Three of its findings this month. It lays out in startling detail the lived experiences of NHS staff and patients who bore through the pandemic. In the report’s words: ‘healthcare systems coped with the pandemic, but only just’.
The BMJ speaks to Kevin Fong, anaesthetist lead for major incidence planning at UCL hospitals, to break down Module Three’s most important takeaways.
And, invasive surgical cosmetic procedures are on the rise in the UK, with regulation patchy at best. From botox and fillers, to tummy tucks and breast surgeries, we hear about the gaps in patient protections that leave space for harm.

Kevin Fong is a consultant anaesthetist, broadcaster, and anaesthetist lead for major incidence planning at UCL hospitals.
Danielle Griffiths is an author and lecturer at the University of Liverpool’s School of Law.
Alexandra Mullock is an author and senior lecturer in medical law at the University of Manchester.

UK Covid Inquiry Module Three Report

Regulating invasive cosmetic procedures to reduce harm | The BMJ

The Gulf states are not large producers of pharmaceuticals or healthcare products - but the oil they supply, and the transport infrastructure they have built, are key components in a worldwide logistical network that underpin all of the pharmaceutical and other medical consumables we use.

From critical NHS shortages like Bone Cement for orthopedic surgery, to persistent IV fluid supply crises plaguing Australian hospitals, we discuss how the conflict in Iran will affect fragile healthcare logistics.

Joining us today are

Mark Dayan, Brexit programme lead at the Nuffield Trust) on NHS procurement problems
Anny Huang, doctor and journalist in Brisbane,on the three-year IV fluid shortages in Australia.
Prashant Yadav a senior fellow for global health at the Council on Foreign Relations, on the potential global effects of the Iranian conflict on international supply chains.

Reading list

Global bone cement shortage: NHS could cancel or delay knee and hip operations

How Australia survived a sudden shortage of IV fluids

Where the Iran War Could Disrupt Pharmaceutical Supply Chains

The lure of health influencers and AI chat bots is strong. More and more people are placing trust in them to answer their health problems, misplaced trust - as we know these AIs can misinform.

At the same time, people are struggling to access the NHS, and when they do doctors have little time or the right tools to unpick complicated science, and challenge misunderstandings.

So in this roundtable, we’re asking, are we in danger of the NHS making the problem of misinformation worse, and what can we do to combat that.

Joining Kamran Abbasi, the BMJ’s editor in chief are:

Deborah Cohen: Freelance Journalist; Senior Visiting Fellow at LSE Health
Kamila Hawthorne: Chair of the National Academy for Social Prescribing
Nnena Osuji: Consultant haematologist and CEO of North Middlesex University Hospital NHS Trust

Chapters

[00:00] The rise of health influencers
[03:55] Patient satisfaction and the NHS
[05:58] The "Infodemic" and clinical impact
[11:04] Digital literacy and health inequalities
[16:40] Questions from the audience

Reading list:

Cohen D. Bad Influence: How the Internet Hijacked Our Health. Oneworld Publications; 2026.
Satisfaction with NHS hits record low, but public still back founding principles - The BMJ

In this episode, Dr Katie Bramall, Chair of the BMA’s General Practitioners Committee, joins the podcast to discuss her concerns surrounding the new GP contract imposed by the UK government.

GP contract overhaul: What's included and how has it been received?

Helen Salisbury: Another imposed GP contract

As public health officials warn about rising emissions from urban wood burning, a BMJ investigation finds that just under a third of UK councils in high use areas have faced pressure from the stove industry to tone down or withdraw campaigns.

Almost a third of UK children live in poverty. Leading expert Michael Marmot weighs in on the UK’s "steepest rise" in child poverty among OECD countries and why local government "Marmot Cities" like Coventry and Manchester are taking the lead where national policy falls short.

And, a new BMJ collection has just been published on child mental health in conflict zones. 1 in 5 children globally live in conflict zones, creating a staggering mental health toll. We hear about community-led interventions.

Reading list:

The growing threat of domestic wood burning stoves—and industry’s legal attempts to shut down clean air campaigns
Michael Marmot: Labour has reneged on its child poverty promises
Child mental health in conflict settings

In this episode, we investigate the alarming resurgence of measles across North America and the UK. While cases are falling across much of Europe and Asia, North America is seeing explosive outbreaks fueled by vaccine hesitancy and political shifts.
We break down the 2026 crisis: Why London is the epicenter and how the UK lost its "Measles Elimination Status". An in-depth look at outbreaks in Ontario, Alberta, Texas, and Mexico. How returning travelers—not migrants—are actually driving the spread. The impact of "shared clinical decision-making" and current US health leadership on vaccine access.

Kamran Abbasi is joined by:

Angela Rasmussen - Virologist, University of Saskatchewan.

Azeem Majeed - Professor of Primary Care and Public Health, Imperial College London.

In this week’s episode, we challenge long-held medical narratives, starting with how the healthcare system manages life after a cancer diagnosis. While medical advancements mean more people are surviving cancer than ever before, many patients report a "cliff-edge" experience where coordinated care effectively vanishes once primary treatment ends. We are joined by Dr. Rosalind Adam, an Academic GP at the University of Aberdeen, who argues that it is time to stop viewing cancer as a discrete, one-off episode and instead integrate it into routine chronic disease management.

Next, we dive into a landmark study from Sweden that is overturning the conventional notion of autism as a predominantly male condition. Historically, autism has been cited as having a 4:1 male-to-female ratio, but new data suggests this gap may be a byproduct of timing rather than biology. We speak with Dr. Caroline Fyfe, a medical epidemiologist at the University of Edinburgh, and Dr. Natasha Marrus, a child psychiatrist at Washington University in St. Louis. They discuss their analysis of 2.7 million individuals, which revealed a significant female catch-up during adolescence, showing that by age 20, the diagnosis ratio approaches 1:1. The team explores why girls are so often missed in childhood and what this shift means for the future of sex-sensitive diagnostic practices.

Reading ListFor more details on the research discussed in this episode, you can access the full papers on bmj.com:

Cancer is a chronic disease: why don’t we treat it as one? Adam R, Hogg DR, Ritchie LD, Nekhlyudov L. BMJ 2026;392:e086624.
Time trends in the male to female ratio for autism incidence: population based, prospectively collected, birth cohort study. Fyfe C, et al. BMJ 2026;392:e084164.

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The House of Lord's amendments to England and Wales assisted dying bill might be causing a constitutional crisis. Lords have tabled 1,277 amendments—which is a record for any equivalent bill in history - and over half of those came from just seven peers.

This has led to accusations of "delaying tactics" or "filibustering" to run down the clock deliberately and run this bill off the road. Although some of these amendments have been described as unworkable, repetitious and unnecessary; others reflect serious, legitimate concerns, around the prevention of coercion, how to identify victims of domestic abuse and the broader impact on the disabled community, and whether it’s wise to introduce assisted dying while palliative and social care services are so stretched.

300 territories around the world, allow physician assisted death - so we asked experts from Canada and California to reflect on those objections, and if there is any evidence of this issues arising where they live.

James Downer is Professor and Head of the Division of Palliative Care at the University of Ottawa, and Catherine Forest is clinical associate professor of family medicine at the University of California San Francisco.

Reading list:

Scrutiny of the assisted dying bill is vital but obstruction in the House of Lords could mean it never becomes law

Deborah Cohen's new book "How the internet hijacked our health" explores the profound impact of the internet on our wellbeing.

In this conversation with BMJ Editor, Kamran Abbasi, they discuss the ways in which online information can both empower and mislead, the role of big tech in shaping our wellbeing and the complex and disturbing ways wellness influencers are becoming more trusted than the NHS.

With insights drawn from extensive research and a deep understanding of the digital landscape, Deborah Cohen sheds light on the critical issues at the intersection of technology and healthcare, and challenges anyone who consumes health information online to think differently about what they're doing.

We’re 18 months into the Labour government, and their changes to the NHS are beginning to be felt. In the 10 year plan that they launched last year, they announced three planned shifts for the health service.

Firstly, they pledge to move care from hospitals to the community, an increased focus on prevention rather than sickness, and shift from analogue to digital with an improved NHS app where patients can access records, seek advice and control some aspects of their care. However, accessing primary care and getting a GP appointment is still a key area of concern for patients and healthcare staff.

In a new research paper on bmj.com, a group of researchers have performed a qualitative study asking 70 patients about their experiences of accessing primary care in England. We're joined by Hugh Alderwick and Luisa Petigrew from the Health Foundation to discuss what the findings mean for the 10 year plan.

Also this week, online gambling is a growing problem. The immediacy of access, combined with advertising and push notifications, and a proliferation of new gambling companies, undermines traditional ways of managing a gambling addiction.

A new analysis argues that these new forms of online gambling requires new forms of regulation. Spencer Murch from the University of Calgery offers some ideas on how that could work.

Reading list

Experience of access to general practice in England

Policies to increase access to general practice may have unintended consequences

Online gambling requires greater government regulation

This interview is available in video form: https://www.youtube.com/watch?v=-yNO47EfuEM

‪
@RichardJMurphy‬, political economist and tax campaigner, joins Kamran Abbasi, Editor in Chief of The BMJ.

In the UK an ongoing dispute between resident doctors and the Labour Government saw doctors go on strike in mid-December. With Winter pressure piling on and cost-of-living on the rise, do doctors have a credible case of pay rises? And more broadly, how can the economic situation of the NHS be improved?

00:00 Introduction
01:30 Doctor Pay Claims
04:33 Inflation Measures
07:29 Affordability Crisis
09:48 Market Forces Arguments
12:52 NHS Affordability
15:00 Youth Unemployment
19:14 Political Priorities
23:10 Neoliberal Capitalism
27:35 Mixed Economy Alternative
32:32 Prescription for NHS

The class of GLP-1 agonist drugs including Ozempic gained a wide reputation for weight loss in 2025. However, it's well established that weight regain is a common result after people stop their doses. We report on new research which aims to quantify what is happening in the here-and-now for patients who stop using these and similar drugs.

Weight regain after cessation of medication for weight management: systematic review and meta-analysis

Also, The BMJ reports on news from Gaza. The Israeli government has issued new directives to strip 37 NGOs of their licences to provide essential aid to the population. This includes Médecins Sans Frontières, the charity directly supporting many of the critically important hospitals in the territory. Gaza is experiencing an especially harsh Winter and MSF warn that this measure could leave Palestinians without lifesaving medical care.

Gaza: Israel moves to ban dozens of aid groups in "cynical and calculated" move
Gaza in winter: 29 day old baby dies of hypothermia amid dire conditions

The BMJ’s annual appeal is supporting the work of Médecins Sans Frontières (MSF). Around the world, MSF teams are providing maternity care, containing outbreaks, and performing vital surgeries. In areas overwhelmed by conflicts and natural disasters, more lives can be saved when we are in the right place at the right time.

Donate today at https://msf.org.uk/bmj-annual-appeal-2025

This episode is available in video form on YouTube: https://youtu.be/1cGrD47eZSk

American science fiction author Kim Stanley Robinson joins Kamran Abbasi to discuss climate disaster, the need for political imagination, and science fiction's vision for health.

Kim Stanley Robinson is the acclaimed author of a trilogy of novels, exploring the terraforming and settlement of Mars. His most recent novel, 'Ministry for the Future', was published in 2020.

'Ministry for the Future' sets out a vision for real solutions to our climate crisis, covering global finance, the animal kingdom, rising sea levels, energy production and much more. The book imagines a Ministry that begins its work in 2025.

Five years after publication, with 2025 past and gone, The BMJ spoke to Robinson to explore how closely the novel's vision for the future has reflected reality.

01:00 BMJ's New Climate Change Initiative
01:21 Kim Stanley Robinson's Ministry for the Future
04:02 The Role of Political Violence in Climate Action
10:50 The Concept of the Carbon Coin
12:51 The Importance of Global Collaboration
27:32 The Role of Medicine in Climate Change
32:33 Youth and Climate Activism
37:53 Hope and Despair in Climate Action
41:29 Conclusion and Future Works

Read more about The BMJ's climate coverage in the latest issue: https://www.bmj.com/content/392/8479

It’s time for 2025’s festive fun!

Practicing medicine can be a very visceral experience - and the English language can’t always adequately capture the sights, sounds, smells. So Matt Morgan, intensivist and BMJ columnist, is creating medical neologisms, and joins us to share a few.

Madhvi Joshi, a GP in London, has written about longevity science, and we hear how the “biohacking” of internet influencers like Bryan Johnson is making its way into the consultation.

Navjoyt Ladher and Tim Feeny take us though this year’s festive research, and are joined by Anupam Bapu Jena from Harvard, who has been looking at self censorship in the time of Trump, and Melanie de Lange, from the university of Bristol, who has been investigating the impact of daylight savings time.

Reading list:

A dictionary for medicine’s unnamed moments
https://www.bmj.com/content/391/bmj.r2476

Science of longevity medicine
https://www.bmj.com/content/391/bmj.r2536

Changes in diversity language in National Institutes of Health grant awards
https://www.bmj.com/content/391/bmj-2025-087222

Acute effects of daylight saving time clock changes on mental and physical health in England
https://www.bmj.com/content/391/bmj-2025-085962

In this episode, we hear how Generative AI is making it into the consultation room - but not through NHS endorsed routes - surveys suggest that ⅔ of doctors are using AI, for backoffice tasks - but also increasingly for information and diagnosis.

David Navarro, a research fellow in generative AI at the Australian Institute of Health Innovation, Charlotte Blease, associate professor at the Participatory eHealth and Health Data Research Group at Uppsala University, and Marcus Lewis, GP in London, reflect on what we know about the real way in gen AI is being used - and what “triadic care” (doctor, patient and AI) will mean for the future of the therapeutic relationship.

We also hear from Teppo Järvinen, professor of orthopaedic surgery at Helsinki University, about surgical subacromial decompression - a 10 year follow up of a double blinded placebo controlled trial, confirms that surgery is no more effective than standard care. Yet surgical interventions continue - we hear why.

Finally, we go to a Cholera clinic in Nigeria, where Médecins Sans Frontières are running cholera treatment centres, which you can help by donating to our Christmas appeal.

Links

Generative AI and the clinical encounter

The BMJ appeal 2025-26: Inside MSF’s response to cholera in Nigeria: a day in the life of an emergency doctor

Arthroscopic subacromial decompression versus placebo surgery for subacromial pain syndrome

There is an enormous amount of research on treatment for ADHD - pharmaceutical and otherwise. But not all of those trials, or meta-analyses, are of high quality; and not many compare the whole literature.

Now a new umbrella review - a review of reviews - tries to give a broad overview of the whole evidence base. Corentin Gosling, associate professor at the Université Paris Nanterre, joins us to set out the benefits and harms of ADHD therapies.

Also, the BMJ’s been investigating the employment of doctors on “local” contracts in the NHS - and our latest look at this exposes what some have described as a “gig economy”, with doctors plugging rota gaps but missing out on training, development, and salary progression. Rebecca Coombes, head of journalism at The BMJ explains more.

Finally, Tom Frieden is former head of the US Centers for Disease Control, and current CEO of Resolve to Save Lives - he’s written a new book on public health. He joins us to talk about what actually improves health at a population level, and why the current US administration’s approach to staffing the CDC is leaving the country open to danger.

Reading list

Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making

Revealed: Thousands of NHS doctors are trapped in insecure “gig economy” contracts

"Damning” and “unforgivable failures” is how some papers headlines reacted to criticism of former UK prime minister Boris Johnson in the second of 10 reports from the UK Covid Inquiry.

Under pressure, in 2001 Boris Johnson announced a covid inquiry led by a former judge, Baroness Hallett. Each report is examining a different area of the pandemic's impact, and module 2 is about decision making and political governance.

The report describes inertia, toxic cultures, and an inability to learn lessons - disfunction that contributed to many extra deaths.

To dissect the report and discuss what needs to change, we're joined by;

Rebecca Coombes - The BMJ’s head of journalism
Kevin Fong - anaesthetist and lead for major incident planning at University College Hospital
Matthew Flinders - Professor of Politics and Public Policy at the University of Sheffield

It’s the BMJ’s annual climate issue - and in this episode, we’ll be hearing about more ways in which climate mitigation is good for health.

Firstly, climate change is fuelling conflict, and exacerbating the impact it has on fragile healthcare systems. Andy Haines, from the London School of Hygiene and Tropical Medicine, and Barbora Sedova, from Potsdam Institute for Climate Impact Research, discuss how climate and conflict intersect, and what they think needs to be done to combat it.

“Car spreading”, the recent tendency for cars to become bigger and heavier is not only harming the climate, but it’s also harming pedestrians. Anthony Laverty, associate professor of public health at Imperial College London, and trauma surgeon Cleo Kenington explain why SUVs are more lethal in accidents, and why France is bucking the trend in sales.

Finally, Jocalyn Clark, the BMJ’s international editor joins us to talk about women’s health innovation and why tech bros aren’t the people to be leading it.

Reading list:

The climate issue: Brazil and the climate crisis

Tackling the complex links between climate change, conflict, and health

Reducing the harms from ever larger cars

Transforming women’s health through innovation

Far right rallies have been held across the UK, culminating in a large parade in London where Elon Musk spoke. At the same time, politicians from across the political spectrum are following the talking points of far right parties - and shifting their policies rightward, even the Labour home secretary has said she wishes to double the period migrants have to be in the UK before they can become citizens.

That has made a group of medics decide it’s time for doctors and other healthcare professionals to use their voice and speak up - against the demonisation of migrants into the UK, and for their fellow NHS staff. They are demanding that those in positions of power do so too.

Some of those medics join us on the podcast today;

Alistair Stewart, consultant psychiatrist in Manchester

Omnya Ahmed, resident doctor in London

Jordan Rivera, occupational therapist in London

Also this week, doctor, researcher, comedian and Matt Hutchinson is adding author to his list, and has released the book “Are You Really the Doctor? My Life as a Black Doctor in the NHS” - he joins Shivali Fulchand to talk about balancing all of this bits of his career - and how standup comedy has helped him maintain his career in the NHS.

Reading list

Everybody’s business: call to all NHS staff to oppose the influence of racism and the far right

This week on the podcast

The BMJ investigates Q-COLLAR, an American device that distributors claim can reduce brain injury from contact sports. Investigators James Smoliga and Mu Yang take us through the evidence, and former NFL punter turned US bobsled team member Johnny Townsend explains what this means for sportspeople.

Bin Wang from Zhejiang University School of Medicine explains what the new network metaanalysis finds is the best exercise options for knee osteoarthritis

And, what our patient panel really think about “patient choice”.

links

How an FDA cleared “brain protection” device built on shaky science made it to the NFL

Comparative efficacy and safety of exercise modalities in knee osteoarthritis

The BMJ's patient and public partnership

In this episode of the podcast;

In July this year, the Government published their 10 year health plan for England - A new analysis just published on BMJ.com takes an in depth look at the chances of that plan succeeding, and where the government needs to focus time and resources. Bob Klaber, paediatrician and director of strategy, research and innovation at Imperial College Healthcare, and Helen Salisbury, GP and columnist for the BMJ join us to discuss.

Journalist Chris Stoker-Walker's grandfather suffered from delirium at the end of his life, but the journey to that diagnosis was difficult - Chris joins us to talk about the impact that had on his family, and Elizabeth Sampson, professor of liaison psychiatry from Queen Mary University of London, explains why it's under-researched.

Finally, we've been reporting from Gaza for 2 years, and it's been very difficult to get accurate information out of the region. However, new research published on bmj.com has surveyed medics there, to document the patterns of wounding in the civilian population - to improve the medical response to the conflict. Omar El-Taji and Ameer Ali, resident doctors in the NHS join us to explain what they found.

Reading list:

Delivering on the 10 year health plan for England

Why can’t we do anything about delirium?

Patterns of war related trauma in Gaza during armed conflict

In today’s episode: Assisted Dying moves closer to becoming UK law. The proposed legislation to allow people to end their own lives has moved through a second debate in the House of Lords. What do MPs and doctors think of the Bill as it stands? And, new ways to pull research findings from observation alone makes us question whether correlation really doesn’t equal causation. We find out - what is Target Trial Emulation?

The BMJ’s Elisabeth Mahase speaks to Labour MP Kim Leadbeater, sponsor of the Assisted Dying Bill. Why did she propose the legislation? What has been her impression of its movement through Parliament and the opposition it has faced? We also hear from Jamilla Hussain and Gareth Owen, doctors who attended a BMJ parliamentary roundtable on the topic.

Finally, the BMJ’s Duncan Jarvies talks to our research editors about new ways to develop evidence from observational studies. What are the limits to this new technique of causal inference?

Reading list

MP behind assisted dying bill warns that terminally ill people and their families are being failed, ahead of Lords debate

Assisted dying bill: Lords debate concerns over lack of safeguards

Transparent reporting of observational studies emulating a target trial: the TARGET Statement

In today’s episode:

Rethinking how we measure the harm caused by the arms industry
The life long, and multigenerational, impact of starvation in Gaza
What is the appropriate focus on prevention in general practice?

The BMJ's international editor, Jocalyn Clark talks about a new series we've just published - examining the arms industry as a commercial determinant of health. Jocalyn also speaks to Mark Bellis, from Liverpool John Moores university about why he thinks it’s time we take the impact of the arms industry on health seriously.

The blockade on food reaching Gaza is in place again, risking more starvation. Elizabeth Mahase, clinical reporter for the BMJ, has been finding out about the acute, chronic, and generational impact on the palestinian population. She speaks to Jonathan Wells, professor of anthropology and paediatric nutrition at University College London, and Tessa Roseboom, professor of early development and health at the University of Amsterdam, Marie McGrath former head of the Emergency Nutrition Network, and Chris McIntosh, humanitarian response advisor for the charity, Oxfam.

Finally, an analysis we published earlier this year made the case that "tsunami" of preventative care is destabilised the work of GPs. Helen Macdonald was at the Preventing Overdiagnosis conference and spoke to some of the authors - Minna Johansson, associate professor at University of Gothenberg, Stephen Martin, professor at UMass Chan Medical School, and Iona Heath, retired GP and former president of the RCGP.

Reading list

Arms industry as a commercial determinant of health

Starvation is a lifelong sentence: Gaza’s civilians must be protected in accordance with international humanitarian law

Sacrificing patient care for prevention: distortion of the role of general practice

CRISPR technology has revolutionised biological research, and for the first time it’s out of the lab and into the NHS, as NICE has approved its use as cost effective. Kenneth Charles, senior lecturer in haematology at the University of the West Indies explains how the treatment works, and what concerns he has about it's implementation.

Also this week, a new investigation on bmj.com has looked at a number of British companies who are offering to collect children's teeth for stem cell extraction and storage. Freelance investigative journalist Emma Wilkinson explains the "outrageous" claims she found them making.

Finally - we’re finishing with the football. Team GB had a strong showing this year - our over 25 men’s team brought the trophy home, and our womans team competed for the first time To explain more about the medical world cup we're joined by Minnan Al-Khafaji, captain of the women’s team, and Jamie Thoroughgood, captain of the men’s team.

Read more.

Banking baby teeth: companies may be misleading parents with “outrageous claims”

CRISPR therapy for sickle cell disease

Follow the British Medical Football Team on instagram

If you’ve been in a high street pharmacy or supermarket recently, chances are you’ll have seen home test kits for all sorts of indications; blood sugar level, vitamin deficiencies, thyroid function, and even some forms of cancer.

A new series of article in The BMJ revealing serious concerns with the reliability of these home tests, and raises questions about their regulation.

Jonathan Deeks, professor of Biostatistics at the University of Birmingham, joins us to discuss what these tests are, and how his team have rated their usability.

Also this week, the sad death of a child in Liverpool from measles highlights the growing outbreak in the UK - and this may be one of the first times many doctors have come across the infection. Frances Dutton, GP at the Small Heath Medical Practice reminds us how to recognise the sign of the infection.

Reading list

Direct-to-consumer self-tests sold in the UK in 2023

How to recognise and manage measles

Professor Gillian Leng, President of the Royal Society of Medicine was asked to carry out an independent review into the role of physician and anaesthetic associates.

She sits down with Kamran Abbasi, editor in chief of The BMJ, to discuss her findings. In the UK, the rollout of physician associates, NHS staff who took on some of the tasks of doctors, has been both haphazard and controversial.

Originally copied from similar roles in the U.S., British PAs were introduced in the early 2000s. The level of clinical responsibility they were asked to take on began to vary around the country, driven mostly by the workforce needs of individual Trusts.

The lack of clarity about their roles lead to disquiet with doctors, worry for patients, and an increasingly toxic debate on social media.

01.00 What is the Leng Review?
10:00 Recommendation one: Renaming
14:00 Recommendation two: Easier identification
16:00 Recommendation three: How to work?
20:00 Recommendation four: Diagnosis
25:00 Recommendation five: Oversight & Regulation
32:00 Prescribing and ordering ionizing radiation?
40:00 A failure of workforce planning and vision ?
49:00 The NHS 10 year plan

This week we’re focusing on the NHS.

On the 3rd of July the UK’s Prime Minister, Kier Starmer finally announced the NHS’ 10 year plan. His Labour government laid out a vision for where the healthcare service should head over the next decade.

The announcement has been met with mixed responses. The plan has some good ideas - but a lack of vision combined with scarcity of detail leave many questions about how well its aims can be implemented.

In this podcast we're joined by 3 experts to dissect the details of this plan

Jennifer Dixon is chief executive of the Health Foundation
Katie Bramhall-Stainer is a working GP, and chairs the BMA’s General Practice committee.
David Oliver is a consultant geriatrician, and a columnist for the BMJ

Reading list

News analysis: What is the NHS 10 year plan promising and how will it be delivered?

Editorial: Government’s 10 year plan for the NHS in England

David Oliver's column: The NHS 10 year plan—more a set of ambitions than a plan

Rebecca Coombes interviews Dr. Tom Dolphin, consultant anaesthetist and newly elected chair of the BMA Council.

Watch this interview on our YouTube.

Last December, The BMJ published an investigation into the 2009 PLATO trial - exposing serious problems with that study’s data analysis and reporting. Our follow up investigation has shown that those data problems extend to other key supporting evidence in AstraZeneca’s initial application to regulators.

Peter Doshi, senior editor in the BMJ’s Investigations unit, and Rita Redberg, cardiologist and Professor of Medicine at UCSF and former editor of JAMA Internal Medicine, join us to explain what this means for scientific integrity, and trust in the FDA's approval processes.

Also in this episode. A group of international authors are arguing that weightloss advice given in primary care might actually be doing more harm than good - it’s ineffective and potentially reinforces damaging stigma.

To explain why they came to that conclusion we're joined by Juan Franco editor in chief of BMJ EBM, and a practicing GP in Germany, and Emma Grundtvig Gram, from the Centre for General Practice at the University of Copenhagen

Reading list

Doubts over landmark heart drug trial: ticagrelor PLATO study

Ticagrelor doubts: inaccuracies uncovered in key studies for AstraZeneca’s billion dollar drug

Beyond body mass index: rethinking doctors’ advice for weight loss

In this episode, we hear about ketamine addiction. It's in the news, but the rise in addiction amongst young people in the UK has caused concern for some time. Irene Guerrini and Nicola Kalk, both addiction psychiatrists from the National Addiction Centre, join us to explain why its become a problem.

In November 2024 Wes Streeting, the UK’s health and social care minister, announced that he was planning to introduce league tables for hospitals - and would be linking managers' pay and continued employment to those outcomes.

Richard Lilford, from the University of Birmingham, Timothy Hofer, from the University of Michigan, and Ian Leistikow, an inspector at the Dutch Health and Youth Care Inspectorate, join us to explain why this is a bad idea.

Non-prescribed ketamine use is rising in the UK

Hospital league tables, targets, and performance incentives should be used with care

Devi Sridhar's new book “How Not to Die (Too Soon) - The Lies We’ve Been Sold, and the Policies That Could Save Us” is focussing on the way wellness culture ignores the societal context in which health is really created. As a trained personal trainer and professor of global public health, Devi's straddling both of those worlds, and joins us to talk about how she would tackle our lowering life expectancy.

Also, John Downey, from the Centre of Health Technology at Peninsula Medical School, and Martha Lee from NHS Devon Integrated Care Board, have written about Plymouth's "Living Lab" - which has been set up to test how health tech can actually work in the real world, but also (importantly, critically) how it can be properly evaluated and integrated into the NHS and social care.

Reading list

How Not to Die (Too Soon)

Harnessing predictive prevention to shift elderly care from hospital to community in England

Recent escalations in the ever simmering tension between India and Pakistan brought us closer to conflict - conflict between two nuclear powers.

For a long time doctors have campaigned for nuclear disarmament, and Chris Zielinski, president of the World Association of Medical Editors, makes the case for returning WHO's mandate to measure the potential impact of nuclear war.

Also the militarization of the region is detrimental to the health and wellbeing of the populations in both India and Pakistan. co-chairs of The BMJ's South Asia editorial board, Sanjay Nagral and Zulfiqar Butta, explain why a focus on the daily material and health needs of citizens is the way to change political rhetoric in the region.

Gordon Guyatt, distinguished professor at McMaster University, was one of the people responsible for starting GRADE - which is a structured system for assessing the quality of evidence in systematic reviews and clinical practice guideline. Gordon thinks that process has become too complicated - so he’s now championing “Core GRADE”. He joins us to explain why.

Reading list

Ending nuclear weapons, before they end us

Why Core GRADE is needed: introduction to a new series in The BMJ

China was declared malaria free in 2021 - and we'll hear how persistence was key to their success, and what new technologies are available to help the rest of the world become malaria free, from Regina Rabinovich, director of the Malaria Elimination Initiative at the Barcelona Institute for Global Health.

Sonia Saxena, professor of primary care at Imperial College London, and Miguel O’Ryan, dean of the medical faculty of the University of Chile join Kamran to talk about what broke academic medicine, and why it's time for a revolution.

New research shows that data from retracted papers is still having an alarming effect on clinical practice. Chang Xu, Hui Liu, and Fuchen Liu from the Naval Medical University in Shanghai, and Suhail Doi from Qatar University, join us to talk about their study which has maped retracted papers impact on systematic reviews and clinical guidelines.

Reading list

Malaria control lessons from China

Vision 2050: a revolution in academic medicine for better health for all

Investigating the impact of trial retractions on the healthcare evidence ecosystem (VITALITY Study I)

An example of the BMJ's approach to updating metaanalysis after a study retraction

The UK government is debating legislation to allow assisted dying in England and Wales, which puts doctors at the forefront of deciding if their patient will be eligible for a medically assisted death - the key criteria being a 6 month prognosis. But is making a 6 month prognosis actually clinically reliable?

To discuss we're joined by a panel of experts on end of life;

Scott Murray, emeritus professor of primary palliative care at the University of Edinburgh
Simon Etkind, assistant professor of palliative care at the University of Cambridge
Nancy Preston, professor of supportive and palliative care, Lancaster University
Suzanne Ost, professor of law, Lancaster University

Reading list

Assisted dying and the difficulties of predicting end of life

Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach

Also in this episode, we dim the lights and raise the curtains - there is a public fascination with doctors who kill and the stage show turned podcast, ‘An Appointment with Murder’, takes a deep dive into the crimes of GPs John Bodkin-Adams and Harold Shipman.

Kamran is joined by Harry Brunjes and Andrew Johns to talk medical murder.

An Appointment With Murder on Apple Podcasts

Kamran Abbasi interviews Professor Ashish Jha, Dean of Public Health at Brown University and former COVID-19 pandemic advisor to President Biden.

Watch this interview on our YouTube.

Trump’s second term has touched everything in the US political sphere - and health is no exception. With research funding for medicine and science weathering under Trump’s storm of cuts, how can Americans who care about public health and data navigate a course through the swells?

Professor Jha discusses how to resist an anti-vaccine resurgence, and comments on revisionist narratives that drive ill-conceived public health policies.

02:20 The MAHA movement and RFK Jnr.
07:40 Does evidence still matter?
13:35 Trump administration is helping China
15:10 Policymaking in Trump’s shadow
23:35 Where do universities go from here?
28:48 Censorship, research funding and academic freedom
33:35 Health inequalities within America
36:20 A resurgent anti-vax message
41:24 What Ashish’s got wrong about the pandemic response
45:31 When is enough for research data?
47:14 Future hope and how to pushback in smart ways

Reading list:

Professor Jha’s December 2024 editorial on the Trump admin’s plans for American healthcare coverage

The UK’s chancellor has announced a £5bn cut to benefits, much of which will be borne by those on long-term disability allowance. Gerry McCartney, professor of wellbeing economy at Glasgow University explains about why these cuts will not only hurt the most vulnerable, but will be counterproductive to the government's wish to get people back to work.

Also, Suzanne O'Sullivan, consultant neurologist and author, joins us to talk about her new book "Age of Diagnosis". The book used clinical cases to explore the issues of medicalisation, and Suzanne explains why overdiagnosis doesn't mean that care isn't needed.

Reading list;

UK welfare reforms threaten health of the most vulnerable

Guardian edited extract from "The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far"

In the UK, the prime minister has announced the disbanding of NHS England, Nigel Crisp - former chief executive of the NHS, explains why he thinks that it’s important the health service is closer to the political decision makers, and why this could be the time to really acknowledge the healthcare emergency.

On the international stage, the Trump administration's withdrawal from the WHO is throwing global health into disarray - Illona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, joins us to explain which new alliances are emerging, why the funding that has disappeared may never be replaced, and how tech will surpass pharma when it comes to industry influence.

Finally, there is a triple burden of malnutrition for adolescent girls in south Asia - which creates a cycle of ill health that is hard to break. However, Zulfiqar Bhutta, chair in global child health at the Hospital for Sick Children in Toronto, thinks the region can come together to change both government and society to champion young women’s health.

Reading list:

Abolishing NHS England: risks and opportunities

https://www.bmj.com/nhs-commission

https://www.bmj.com/collections/nourishing-south-asia

We've just published a new rapid review on the safety and efficacy of physician and anaesthetic associates in the UK, which was commissioned to support the ongoing Leng review of these new roles in the NHS. Trish Greenhalgh, professor of primary care at the University of Oxford, joins us to discuss the data she found.

Habib Naqvi is director of the NHS Race and Health Observatory, and is holding up a mirror to the NHS on it's support for ethnic minority patients and doctors - he joins us to talk about the work they've done, and why Reform UK's manifesto pledge to disband the Observatory is a matter of pride.

Finally, our annual trip to the Nuffield Summit is not complete without a roundtable, this year we asked the question "What is stopping staff from speaking up?". Our panellists raised the usual issues of hierarchy and psychological safety, but also how the lack of positive change from senior leadership has habituated people into thinking "why bother".

Our panel;

Katie Bramall-Stainer, chair of the General Practice Committee of the BMA
Jugdeep Dhesi, consultant in geriatric medicine at Guys and St Thomas Hopsital
Henrietta Hughes, the UK's patient safety commissioner
Thea Stein, chief executive of the Nuffield Trust

Reading list

Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research

Together we can challenge the racism that persists in healthcare

From pay restoration, to making sure there are enough training posts for resident doctors, the BMA has been busy.

In this podcast, Kamran Abbasi, the editor in chief of The BMJ, spoke to Phil Banfield, chair of the BMA’s council.

They talk about the ongoing pay discussions, how the BMA is working with the new government - touching on both speciality training places, and the role of physician assistants.

The conversation also covers the BMA's changing strategy, which aims to empower local members to take on the fights they care about, and how the organisation is linking both their trade union and professional activities.

In this episode of the BMJ's Medicine and Science podcast, editor-in-chief Kamran Abbasi discusses the urgent need to tackle disinformation in health, especially in the context of the US, with Heidi Larson and Martin McKee from the London School of Hygiene and Tropical Medicine. We also hear from Jane Ballentyne, professor of anaesthesia and pain medicine at the University of Washington, about new guidelines that strongly recommend against the use of spinal injections for chronic pain - and why that recommendation might be hard for some patients and doctors to hear. Finally, we revisit the progress made in addressing racism in UK medical schools over the past five years with Gareth Iacobucci, The BMJ's assistant news editor. Running order01:44 Defining Misinformation and Disinformation04:08 Vaccines and Misinformation05:38 Strategies to Combat Disinformation10:04 Denialism and Its Implications16:21 BMJ Rapid Recommendations on Spinal Injections26:27 Racism in Medical Schools: An Update Reading listSpinal interventions for chronic back painRacism in medical schools: are things improving?

Providing quality healthcare is demanding, often stressful, and requires sustained effort. When resources are stretched and pressure mounts, compassion can slip - but compassion is an essential tool for leaders, who need to support their teams to continue delivering the best possible care.

In this final episode of The BMJ’s podcast series on quality of care, Rachael Hinton, BMJ Editor, speaks to three healthcare leaders. They discuss how fostering kind and compassionate leadership and care can improve morale, combat burnout, and contribute to better patient outcomes.

01:48 Lydia Okutoyi talks compassionate leadership in Kenya

08:39 Pedro Delgado talks refocusing on the human factor and tools for kind leadership

15:02 Alexander Ansah Manu talks reaping quality of care benefits in Ghana

This podcast was produced as part of the BMJ Collection on Quality of Care, developed in partnership with the World Health Organisation and the World Bank. Visit bmj.com/qualityofcare to view the full Collection. The BMJ commissioned, edited, and published this podcast. This episode edited by Brian Kennedy.

This week Rebecca Coombes is back with another big-food investigation, this time about fast-food giant MacDonalds subverting attempts to stop it opening stores near schools.

Sticking with industry behaving badly, May van Schalkwyk, from the University of Edinburgh, wonders why we haven't learn lessons from the attempts to control big tobacco companies, when it comes to other industries that harm health.

And finally, AI in healthcare - Karim Lekadir, from the University of Barcelona, explains new guidelines which can help evaluate which AI applications are trustworthy.

Reading list

McDonald’s triumphs over councils’ rejections of new branches

FUTURE-AI: international consensus guideline for trustworthy and deployable artificial intelligence in healthcare

Exercise and a better diet, prior to surgery, can improve outcomes. Daniel McIsaac, a professor of anaesthesiology from the University of Ottowa and lead author of that research, joins us to talk about getting those results into practice.

Julia Sinclair, professor of addiction psychiatry at the University of Southampton, explains how the NHS has lost sight of the impact alcohol consumption has on clinical care, and why we need a strategy to tackle it.

Finally, Matt Morgan, consultant in intensive care and BMJ columnist, has written another book - this time about patients who are revived after cardiac arrest, and the profound effect it can have on their outlook in life.

Reading list:

Relative efficacy of prehabilitation interventions and their components

UK needs national strategy to tackle alcohol related harms

A Second Act

US President Donald Trump has signed an executive order to withdraw the US out of the WHO. This would cut funding for the UN’s medical agency by one-fifth.

Will they really exit, or can a deal be made? Lawrence Gostin hopes so, and as a professor of law at Georgetown, and director of the World Health Organisation Collaborating Center on National and Global Health Law, he is working with senior US and WHO officials to try and understand what reforms could be made to WHO what would allow a such a deal to be be struck.

Gostin also believes that the president cannot withdraw from the WHO with an executive order, but instead requires congressional approval - and is exploring the options for legal challenge to the move.

00:00 Intro

01:01 US history with the WHO

03:31 Executive order

06:35 WHO’s relationship with China

11:14 Funding

12:47 Benefits to US from the WHO

18:05 H5N1 threat

19:43 World benefits from US involvement

21:57 A deal to be made?

24:55 Legal action?

26:37 Administration responses

Read Professor Larry Gostin’s co-written opinion piece on the dangers of a US withdrawal from the WHO here: https://www.bmj.com/content/388/bmj.r116

In the last podcast of 2024, Richard Smith, former editor of The BMJ and head of UKHACC will be making the case for being more convivial. Tina Korownyk, professor of family medicine at the University of Alberta is the ghost of Christmas past for TV doctors.

Tim Feeny and Navjoyt Ladher take us through this year's Christmas research papers.

And finally, Mari Martensen, a paramedic, explains what makes being a medic in Svalbard bear-able.

Reading list.

The dangers of industrialisation—why we need to rebuild a convivial society
Televised medical talk shows—what they recommend and the evidence to support their recommendations
Christmas 2024: How to transport a polar bear, and other idiosyncrasies for Arctic emergency medical services
The full Christmas archive

Conflicts of interest harm health, and a new investigation uncovers the infiltration of big food manufacturers into UK schools. Emma Wilkinson reports on that investigation. Kamran and Rebecca Coombes, head of journalism, discuss moves to reduce industry's impact on food policy in the UK.

A new research paper has identified a link between eating chocolate and lower rates of diabetes. Binkai Liu, doctoral student and Qi Sun, associate professor, at the Harvard T.H. Chan School of Public Health explain what they found.

Finally, Sam Hutt is a doctor in the NHS, but is better known by his stage persona “Hank Wangford”. Hank performed a celebration of the NHS at Glastonbury this year, and has now released that song. He joins us to talk about what inspired him.

Reading list

Food industry has infiltrated UK children’s education: stealth marketing exposedChocolate intake and risk of type 2 diabetesHank Wangford

In today’s episode, new research, which has looked at the impact staff turnover is having on patient outcomes. Giuseppe Moscelli, associate professor at the University of Surrey joins Navjoyt Ladher to explain more.

Also, every year the BMJ has a Christmas appeal - and this year we have chosen the International Rescue Committee as our partner. To talk more about what they do, and to give us some insight into how geopolitics are affecting health we're joined David Milliband, president and chief executive officer of the International Rescue Committee, and former UK foreign secretary.

Reading list;

Nurse and doctor turnover and patient outcomes in NHS acute trusts in England

The BMJ Appeal 2024-25: David Miliband on hospital attacks, Trump, and the International Rescue Committee in a “flammable world”

This week we’re at the World Innovation Summit for Health, where we’re a media partner - the meeting is focussing on conflict, equity and resilience.

In that vein, we’re joined by Christos Christou, international president of Médecins Sans Frontières (MSF) to talk about attacks on healthcare staff, and the difficulty and importance of maintaining neutrality in conflict zones.

Ara Darzi, surgeon, executive chair of the conference, and author of the recent NHS review, joins us to talk about antimicrobial resistance, and how diagnostics and a small funding commitment could head off the problem.

And finally, we change our focus to the US, and hear about new research into adverse events during surgery with authors Antoine Duclos and David Bates from Harvard Medical School.

Reading list.

We need to do more to keep antibiotics working

WISH report - Tackling Antimicrobial Resistance: How to Keep Antibiotics Working for the Next Century

Safety of inpatient care in surgical settings: cohort study

In this episode, we speak to the doctor overseeing the WHO’s emergency response for the eastern mediterranean region - including Gaza, Lebanon, Sudan and Yemen. Richard Brennan joins us to talk about protecting health services, and workers, in the escalating armed conflicts that are affecting the region.

Menaka Paranathala and Emma Rourke, from The BMJ, are on to talk about improving research into women’s health. A new UK project, MESSAGE, aims to give consideration to sex and gender in life science research.

Palliative care is not just for end-of-life, and rethinking how it’s integrated into every speciality is the key to improving care for patients, argue Richard Harding, Anna Peeler, and Oladayo Afolabi from the Cicely Saunders Institute.

Links

WISH report - Protecting Health in Armed Conflict
MESSAGE (Medical Science Sex and Gender Equity) project
BMJ Opinion - Palliative care is an overlooked global health priority
WISH report - Palliative Care

It’s an often cited statistic that if healthcare was a country, it would be the fifth largest carbon emitter. At The BMJ we want to change that, and move healthcare towards a more sustainable future.

In this week’s episode, we’ll hear about our annual climate edition from two of The BMJ’s editors, Sophie Cook and Juliet Dobson.

We’ll be diving into Cli-Fi and asking how climate fiction can galvanise our collective response to climate change. Our panel includes Howard Frumkin, professor emeritus at University of Washington. Lakshmi Krishnan, internist and Director of Medical Humanities at Georgetown university, and Sarah Grossman, journalist and author of Fire So Wild.

And Finally, Tereza Kasaeva, director of the WHO’s Global Tuberculosis Programme, explains how migration and food insecurity, exacerbated by climate change, are affecting TB - and why, despite effective treatment, there are still over a million deaths from the disease annually.

Our panel's cli-fi book recommendations

A Fire So Wild - Sarah Grossman
The Last Man - Mary W. Shelly
The Broken Earth - NK Jemisin
Oryx and Crake - Margaret Attwood
The Ministry for the Future - Kim Stanley Robinson
Olga Dies Dreaming - Xóchitl González
Land of Milk and Honey - C Pam Zhang
Day of the Triffids - John Wyndham

Links

The BMJ’s annual climate issue
Cli-Fi—helping us manage a crisis
Writing towards a healthier future amid climate disaster
WISH report - Tuberculosis

Lakshmi’s references

Fundamental Role of Arts and Humanities in Medical Education
Capable of being in uncertainties’: applied medical humanities in undergraduate medical education
The introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessity
The medical humanities at United States medical schools

How science can be transformed into policy?

One of the seemingly intractable issues when it comes to legislative change in the US is gun control. One reason policy change is so difficult, is the US specific evidence vacuum, but that’s beginning to change.

We're joined by Louis Klarevas, an academic at the University of Colombia and author of the book “Rampage Nation, securing america from gun violence" and Shannon Watts, from Moms Demand Action which is a grassroots movement of Americans fighting for public safety measures that can protect people from gun violence.

Even when there is evidence, the trade-offs needed for legislative change can still paralyse policy makers. Citizen assemblies, a form of democratic participation that asks the public for their views, has helped clarify some key healthcare issues, from assisted dying in Jersey, to abortion access in Ireland.

Rebecca McKee from the Institute of Government argues they could be used to fix the NHS, and joins us to explain how.

Reading list

More gun regulation, less firearm harm

Citizens’ assemblies, health, and health policy

Under-nutrition harms health, but so does over-nutrition.

The Bill and Melinda Gate’s foundation has just released their Goalkeepers' report - highlighting the detrimental impact that poor nutrition is having on children’s health. Rasa Izadnegahdar, director of Maternal, Newborn, Child Nutrition & Health at the foundation joins us to explain how they are targeting nutritional interventions.

Also this week, a new investigation in The BMJ has found that the UK government’s Scientific Advisory Committee on Nutrition - the people who help guide the UK’s nutrition policy - have competing interests with the food industry. We hear from Chris van Tulleken, University College London; Rob Percival, the Soil Association; and Alison Tedstone, chair of the Association for Nutrition.

Reading list:

Goalkeepers Report 2024

UK government’s nutrition advisers are paid by world’s largest food companies, BMJ analysis reveals

There's a real drive to strengthen quality of care in facilities around the world. However, no matter where you are, improving healthcare depends on quality data—and collecting and using that data can be challenging without the time and expertise. In this podcast, we explore how different healthcare systems, especially those with limited resources, are tackling the challenge of data collection and use head-on. The BMJ has partnered with the World Health Organization and the World Bank on a Collection on Quality of Care. This podcast, the second in a series exploring themes from the Collection, features researchers and implementers from Ghana, Qatar, and the US. They share insights on improving and using data in resource-constrained environments, offering valuable perspectives relevant to healthcare systems worldwide facing similar challenges. Provenance statement:This podcast is part of a Collection on Quality of Care proposed and funded by the World Health Organization and the World Bank. The BMJ commissioned, edited, and published the podcast. Emma Veitch, Rachael Hinton and Duncan Jarvis were the lead editors for The BMJ.

The news that GPs in England have voted for industrial action has spooked the healthcare system - Katie Bramall-Stainer, the chair of the BMA's General Practice Committee explains what's lead to this, and why trust in the government has gone.

After the games, olympians and paralympians return to their normal lives - but what does that mean for their healthcare, especially in the US where insurance is expensive? Jonathan Finnoff, chief medical officer for the US Olympic and Paralympic committee joins us to explain how athletes are supported outside the games.

Reading list;

GP leader: “If general practice is the bedrock of the NHS, then the NHS is collapsing”

This week we're questioning the effectiveness of the Gallery Test for early cancer detection with investigation authors Margaret McCartney and Deborah Cohen. They delve into the decision-making and politics behind this test's introduction in the UK.

The episode also covers the growing NHS waiting list crisis and how Imran Ahmed and his team at Guy's and St. Thomas' NHS Trust are using high intensity theatre (HIT) lists to increase surgical throughput - and what other teams need to know, if a national rollout of this model is to happen.

Reading list

Galleri promises to detect multiple cancers—but new evidence casts doubt on this much hyped blood test

Are surgical HIT lists the answer to bringing down NHS waiting times?

The Paris games have just started - and France has made a concerted effort to ensure that this year's Olympics will have a legacy of physical activity for the whole population.

However, mega sporting events don't always have that effect, and Fiona Bull, head of physical activity for the WHO, joins us to explain why it's increasingly important that they do.

We'll also hear from Professor Sir Denis Perera Gray about how a lifetime of general practice, and why continuity needs to be at the heart of any improvement to primary care.

Finally, Harry Brunjes went from being a village GP to the chair of English National Opera, and explains what the two careers have in common.

Reading list

Olympic Games: linking sports mega events to population physical activity

We celebrate 10 years of patient and public partnership strategy at The BMJ with a patient-centred podcast.
We ask how should the new Labour government engage patients in shaping the future of the NHS. We also dive into the concepts of social care and peer support, and learn from Brazil's experience in social participation.

Highlights:

01:52 - The Patient "takeover"
05:43 - Social care with Charlotte Augst
19:53 - Peer support groups with Claire Reid and Partha Kar
31:48 - WHO’s resolution on social participation with Mark Barone

Reading:
Editor's Choice - Listening to patients at all levels of healthcare, Emma Doble, patient editor

Women's Health, breast cancer screening, epidurals, and GP voices

New U.S. guideline on breast cancer screening have been extended to women in their 40s - Katy Bell, from the University of Sydney, and Stacey Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm.

Research in The BMJ shows epidurals during labour can reduce severe maternal morbidity Rachael Kearns describes why analgesia may improve those outcomes, and why some myths about epidurals may be reducing their usage.

Lastly, a GP confronts the Prime Minister on the disintegration of the NHS and its effects on general practitioners.

02:23 Breast cancer screening guidelines

14:00 Epidurals and maternal morbidity

26:42 A GP confronts the Prime Minister

Reading list:

Breast cancer screening from age 40 in the US

Epidural analgesia during labour and severe maternal morbidity: population based study

GP who confronted Rishi Sunak received “hundreds” of supportive messages from doctors

As increasing numbers of mammalian, and human, cases of H5N1 are documented we askShould we worry about a growing threat from “bird flu”? Wendy Barclay, from Imperial college London, and Christopher Dye, from Oxford University join us to explain why they think we should.

Our commission on the future of the NHS has released a manifesto for a sustainable NHS that still meets it's founding principles. Helen Salisbury, GP and BMJ columnist, joins the podcast to lay it out.

Finally, a musical interlude from the World Doctor's Orchestra.

00:18 H5N1 Bird Flu: Rising Threat15:35 The manifesto for a better NHS27:46 World Doctors' Orchestra Reading list;BMJ Editorial - Should we worry about a growing threat from “bird flu”?BMJ Opinion - A manifesto for a healthier NHS, a healthier UK
https://www.world-doctors-orchestra.org Stay up to date with our daily email alert - https://www.bmj.com/today

In the UK, a general election has been called - and around the world, ½ the global population will be voting this year; so in this episode we’ll be talking about how elections and health intersect.

Firstly, what are the UK parties’ plans for health? Abi Rimmer, The BMJ's UK features editor joins us with the latest information.

The world’s largest democracy is polling, so how are Indian politicians talking about health? Sanjay Nagral, surgeon and director of the Department of Surgical Gastroenterology at Jaslok Hospital & Research Centre in Mumbai takes us through the campaign promises.

And finally, Jody Heymann is founding director of the WORLD Policy Analysis Center at UCLA and explains why this is the most consequential US election for woman's health in a generation.

01:30 Election Fever and NHS Plans07:35 Impact of Elections on Health in India21:20 Women's Health in the US Elections Reading listFeature: The untold health toll of votingEditorial: Workplace rights around pregnancy and childbirth

With the anticipation of a new government in the UK, shadow health secretary Wes Streeting will hit the ground running - with a winter season (and it's inevitable crisis) and ongoing industrial desputes with junior doctors. Elisabeth Mahase ask him about his plans to handle these challenges if elected.

We also find our selves in the puzzling situation of potential GP unemployment in the UK despite a high demand for primary care doctors, Helen Salisbury, GP and columnist for The BMJ explains how we've got into this situation.

Finally, Peter Doshi has been looking at the financial entanglement of FDA heads with the companies they are regulating - 9 of the previous 10 FDA heads have gone on to work for industry in some respect. He has also investigated how complex financial instruments can make these conflicts more opaque.

02:03 Anticipating a New Government and the NHS Winter Crisis
10:50 The Kafkaesque Dilemma of GP Unemployment
23:10 FDA Leaders' Financial Entanglements: A Deep Dive

Reading list

Workforce and winter under Labour: Wes Streeting on his plan for the NHS

Helen Salisbury: No jobs for GPs—we’ll be missed when we’re gone

Revolving doors: board memberships, hedge funds, and the FDA chiefs responsible for regulating industry

Where next for psychological safety? Amy Edmundson is professor of Leadership and Management at the Harvard Business School. Her work on psychological safety has underpinned so much quality improvement, and she joins us fresh of the stage at the International Forum on Quality and safety in healthcare to talk about the next steps in creating a safe work place.

The BMJ has published two new investigations, looking at the alcohol and tobacco industry funding of public health and education - we’ll hear how the companies who create the problems, are now styling themselves as the solution. Rebecca Coombes joins us to explain what The BMJ has found, and May van Schalkwyk, a researcher from the London School of Hygiene & Tropical Medicine, explains how commercial conflicts are shaping the wrong education tactics.

And finally, our NHS commissioners have more recommendations - this time on workforce issues. Mary Dixon-Woods, director of THIS institute at the University of Cambridge, and Matt Morgan, intensive care consultant in Cardiff, tell the NHS to get serious about staffing.

02:03 Amy Edmondson on Future Health and Psychological Safety
10:24 The Impact of Corporate Funding on Public Health
19:57 Addressing NHS Workforce Challenges: Insights and Solutions

Reading list;

Our new podcast - Future Health

International forum keynote - Medscape caves in on courses funded by tobacco giant Philip Morris, while medics fear global push into medical education
Investigation - Big alcohol: Universities and schools urged to throw out industry-funded public health advice

Commission on the future of the NHS - The future of the NHS depends on its workforce

Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group.

In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them.

They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all.

Reading list

The Cass Review - final report

The systematic review and meta-analyses published in Archives of Disease in Childhood

BMJ Opinion: Gender medicine for children and young people is built on shaky foundations

Derogation, the way in which striking doctors can be recalled to the ward to protect patient safety, was agreed by NHS England and the BMA. Now, new data The BMJ has uncovered shows that the mechanism was rarely used - and when it was tried, was often rejected. Gareth Iacobucci explains what that means about relations between the government, the NHS, and doctors.

Felice Jacka, director of the Food & Mood Centre at Deakin University, is one of the authors of our recent ultra-processed foods umbrella review - and joins the podcast to talk about the link between diet and health; and why goverments need to pay more attention to the food system.

Finally, John Appleby, senior associate at the Nuffield Trust, and Gillian Leng, dean and president elect of the Royal Society of medicine, have been thinking about healthcare funding, and how more stability is essential in securing the service's future.

Reading list

Hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show

Ultra-processed food exposure and adverse health outcomes

NHS funding for a secure future

Chapters

00:31 Derogation and doctor strikes06:59 Ultra processed food producers and health13:59 Rethinking NHS funding

In this week's podcast: How AI will affect the clinician-patient relationship? Our annual Nuffield Summit roundtable asks how the promise of tech tools stacks up against reality, and how the future of the therapeutic relationship can be protected (participants below). Your code is as important as your methods, which is why The BMJ now requires you to share it - Ben Goldacre and Nick De Vito, from the Bennett Institute for Applied Data Science at the University of Oxford, explain why it's so important, and how The BMJ's new data and code sharing policy could change research transparency. Nye Bevin set up the NHS when the UK was in the economic doldrums, and the public's need for care was becoming an emergency - BMJ columnist Matt Morgan has helped turn that story into a play, currently showing at the National Theatre; and reflects on the parallels between now and then. 1:58 Nuffield Summit roundtable17:32 New BMJ rules on data and code sharing29:03 Aneurin "Nye" Bevan play Taking part in our roundtable were:* Rebecca Rosen, Senior Fellow at the Nuffield Trust and GP * Juliet Bouverie, CEO of The Stroke Association * Daniel Elkeles, CEO of London Ambulance Service * Neil Sebire, Professor and Chief Research Information Officer at Great Ormond Street Hospital

Reading list:How is technology changing clinician-patient relationships?

Mandatory data and code sharing for research published by The BMJ

Scalpels and spotlights: bringing theatre to the theatre

The U.S. Supreme Court is hearing a case on the approval of mifepristone for medical abortion - a case which could change the availability of the drug in the US, and which hinges on papers linking abortion to mental distress. However, those papers are contested (including a paper published by BMJ), and some have been retracted already - Julia Littell and Antonia Biggs tell us how that science is being used in court, and why retraction is essential.

Awakening from anaesthetic is difficult enough, but imagine you're three and only communicate through sign language - which no one can understand. We hear from Kirsten, a mother who thinks everyone should learn at least a few key sign language phrases.

Finally, the London Medical Orchestra is turning 70 - having had their start in The BMJ's letters pages. Stuart Delve and Peter Gough help explain the orchestra's longevity.

01:00 The Supreme Court Case on Medical Abortion

10:27 The Role of Journal Editors in Scientific Integrity

19:54 The Impact of Deafness on Patient Experience

30:57 The Joy of Music in a Medical Career: London Medical Orchestra

References

Analysis: Correcting the scientific record on abortion and mental health outcomes

WYPIT: The importance of British Sign Language

Asha's instagram for BSL tips

London Medical Orchestra's 70th anniversary concert - 6:30pm, Sun, 10 Mar 2024

Social media, and the rate at which the online world is changing, is worrying - especially the speed at which health disinformation can speed around the globe. We look to tech companies for a solution to the problems of their own making - but Heidi Larson, director of the Vaccine Confidence Project, and professor of anthropology, risk and decision science at LSHTM, joins us to explain why we should be cautious about focussing our attention there.

Next on the podcast, research just published in The BMJ looks at the efficacy of exercise at controlling depressive symptoms - but helps finally answer the key question - which exercise works best. Lead author, Michael Noetel, senior lecturer in psychology at the University of Queensland, joins us to explain the research, and how well exercise stacks up against pharmacological treatments.

Finally, while it’s tempting to try and put the pandemic behind us, its effects linger - and many healthcare staff are still dealing with their experience of that time. Rachel Clarke, a palliative care doctor in the UK, joins us to explain why she has felt the need to document the pandemic, first in a book and now in a new TV drama set to air in the UK next week.

06:15 Heidi Larson on vaccine confidence and social media

15:31 Exploring the effectiveness of exercise for depression

26:56 Rachel Clark on seeing her experiences reflected on screen

Reading list

BMJ Collection: How are social media influencing vaccination

Feature: Medical misinformation on social media—are the platforms equipped to be the judge?

Research: Effect of exercise for depression

With a new logo, and new music, comes a revamped The BMJ Podcast.

Every two weeks we’ll be bringing you a magazine style show, more variety and perspectives on medicine, health, and wellbeing.

In this episode:
* Former chief executive of the NHS, Nigel Crisp, explaining why the UK is facing a national health and care emergency (01:22) * The guest editors of our US covid series, Gavin Yamey and Ana Diez Roux, discuss the US pandemic response, and how problems are built into the US constitution (19:48) * How The BMJ’s ActionAid appeal will help people in Gaza, Syria and Somalia (33:06)

Reading list:* The BMJ Commission on the Future of the NHS * US covid-19 lessons for future health protection and preparedness * The BMJ Appeal 2023-24: ActionAid offers immediate and long term help

In this festive edition of the BMJ podcast, we hear about what medicine can learn from music, when it comes to giving a convincing performance, and how we can grow an evidence base for nature prescribing.

Professors Roger Kneebone and Aaron William of the Centre for Performance Science raise the curtain on the performance of medicine, and we hear what your consultation technique could learn from a hairstylist.

Ruth Garside, Professor of Evidence Synthesis, Kerryn Husk, Associate Professor of Health Sciences and Edward Chapman from the Health and Environment Public Engagement Group then discuss 'nature prescribing', and wonder about how to balance maintaining the joy derived from nature and yet create an evidence base for the medicinal benefits associated with it.

Reading list

Medicine: a performing art

Nature prescribing

00:13 Introduction to the BMJ Podcast
00:36 Exploring the Themes of the Christmas Edition
01:38 The Intersection of Medicine and Performance
02:33 The Art and Science of Performance in Medicine
05:04 The Role of Performance in Music
06:29 The Similarities Between Medicine and Music
08:06 The Role of Experiential Learning in Performance
14:11 The Impact of Audience on Performance
19:04 The Benefits of Nature and Green Prescribing
24:52 The Challenges of Measuring the Impact of Nature Prescribing
30:37 The Community's Engagement with Nature Prescribing
33:01 Conclusion and Farewell

There’s an inherent tension between creating quality standards that are very clinically focussed, and standards which are very patient centred - especially in settings where clinical outcomes can be compromised by basic lack of resources.

The use of oxytocin to prevent bleeding after birth is an example of this - WHO quality guidelines clearly measure and incentivise use of the drug, but in more wealthy healthcare systems, adherence patient preference is the key measure.

How can we ensure that less wealthy healthcare systems are also patient centred?

Our guests for this discussion;

Nana Twum-Danso, senior vice president, Institute for Healthcare Improvement (IHI)

Paul Dsane-Aidoo, health specialist, UNICEF Ghana

Keith Cloete, head of department at Western Cape Government: Health

Hosted by Emma Veitch, Collections editor for The BMJ

This podcast is part of The BMJ Quality of Care collection, in collaboration with the World Health Organization and the World Bank, which offers critical thinking on both the unfinished agenda and emerging priorities for improving quality of care in low- and middle-income countries.

00:00 Introduction to the podcast

00:48 Introduction of experts and their backgrounds

02:54 Challenges in healthcare systems: south africa's perspective

04:15 The importance of patient-centred care

04:56 The role of data in improving quality of care

06:11 Community engagement and feedback in healthcare

07:58 Tackling global disparities in healthcare

08:41 Balancing clinical outcomes and patient-centred care

10:58 Addressing inequities in healthcare

22:43 The role of governance in improving quality of care

32:56 Overcoming resource constraints in healthcare

36:22 The need for system redesign in healthcare

37:18 Adapting to changing times in healthcare

In this specially curated three-part podcast series from The BMJ, we explore the importance of community and connection to foster adolescent wellbeing.

The discussion covers athe wide array of issues young people face, with a particular focus on the unique challenges of adolescence from a social perspective. The episode unpacks the significance of having supportive relationships within families, schools, and communities and the influence of these relationships on the mental and behavioural health outcomes of adolescents.

It also explores the impact of digitalization on adolescent connection, with discussions on how to balance online interactions with offline engagements. Importantly, it highlights the need for further research into understanding digital and social media interactions and their influence on the health and wellbeing of adolescents in a rapidly evolving digital landscape.

Our guests:

Ulises Ariel Vélez Gauna, Transmitiendo Diversidad

Flavia Bustreo, Fondation Botnar

Richard Dzikunu, YIELD Hub

Shelani Palihawadana, Young Experts Tech for Health.

Joanna Lai, United Nations International Children’s Emergency Fund (UNICEFUnicef)

Hosted by Adam Levy

Supported by the Fondation Botnar and PMNCH, the Partnership for Maternal, Newborn, and Child Health. Read the full cCollection of articles showing the importance of investing in adolescent wellbeing.

00:04 Introduction to the podcast series

00:36 Understanding adolescence from a social perspective

01:00 The impact of community and connection on adolescents

01:07 Personal experiences: growing up as an LGBT+ teenager

01:38 The role of supportive relationships in adolescents' lives

02:05 The importance of connectedness in adolescence and beyond

03:27 Treating safe spaces for LGBT+ adolescents

05:23 The unique role of community during adolescence

07:02 The impact of political landscape on LGBT+ community

07:54 The importance of community and connectedness: expert opinions

08:56 The interconnection of social, health, and educational well-being

12:14 The role of digital technology in adolescents' lives

16:56 The importance of investing in adolescents' well-being

43:18 The role of schools in fostering connectedness

45:41 Conclusion: personal reflections on connectedness

This is the second episode of a special three-part podcast series that delves into adolescent health and wellbeing, focusing on creating a positive trajectory of health from a young age.

The podcast explores physical and mental health issues affecting young people globally, particularly in sexual and reproductive health. We hear how young people are excluded from decisions about their own health, and how grassroots groups around the world are empowering them to take responsibility for their own wellbeing.

We also hear how young people are becoming leaders in social movements, from tackling structural racism to improving nutrition in schools, and how their unique perspectives are vital in making those changes.

Our guests:

Natasha Salifyanji Kaoma, Copper Rose Zambia

Alaa Murabit, The Bill and Melinda Gates Foundation

Donald Bundy, London School of Hygiene and Tropical Medicine

Anshu Banerjee, World Health Organisation

Dev Sharma, Bite Back 2030

Hosted by Adam Levy

Supported by the Fondation Botnar and PMNCH, the Partnership for Maternal, Newborn, and Child Health. Read the full cCollection of articles showing the importance of investing in adolescent wellbeing.

00:05 Introduction to adolescent health

01:00 Young womens’ menstrual health

02:11 Discussion on candid pride project

03:29 Importance of sexual and reproductive health

04:49 The role of young people in health advocacy

06:17 The epidemiology of early health and lifecourse

10:08 Impact of adolescent health on future generations

18:29 How young people become activists

28:51 Advocacy for women in Libya

28:54 Global forum for adolescents

40:15 Success stories

44:54 Conclusion and preview of next episode

In the final episode of this three-part podcast series from The BMJ, we dive into the vital topic of education for adolescents and how it influences the course of life.

This podcast explores barriers, burdens and possibilities of change in the educational system to better support young people, and how the traditional system of schooling is failing to equip young people with the skills and knowledge to lead healthy lives.

We also hear how the value of informal education and its impact on subjects ranging from health to gender equality, and that learning isn’t limited to young people, and the intergenerational benefits of education and its role in shaping societal norms and individual health.

Our guests;

Maziko Matemvu, Uwale

Joanna Herat, UNESCO

Janani Vijayaraghavan, Plan Canada

Atika Ajra Ayon, Plan International

Stefan Germann, Fondation Botnar

Hosted by Adam Levy

Supported by the Fondation Botnar and PMNCH, the Partnership for Maternal, Newborn, and Child Health. Read the full cCollection of articles showing the importance of investing in adolescent wellbeing.

00:03 Introduction to the podcast

00:11 The importance of education for adolescents

03:26 The role of education in health and wellbeing

04:43 The impact of education on society

10:21 The power of peer education

11:15 The role of media in education

12:31 The importance of meaningful engagement in education

14:45 The impact of education on health

17:48 The challenges in access to education

26:25 The role of education in combating child marriage

36:37 The impact of climate change on education

44:53 The role of education in mental wellbeing

45:59 Conclusion of the podcast

The December edition of the Talk Evidence podcast discusses the complexities of seeking consent from patients who are part of large data sets, and some new research to help patients living with diabetes in places without certain power supplies.

First patient consent and data - in the UK, two stories that have made the public worry about the use of their health data. Firstly the news that UK biobank, who hold a lot of genomic and health data, allowed research by an insurance company, and second that the NHS has entered a contract with Palentir to do analysis on NHS data.

Natalie Banner, director of ethics at Genomics England has been thinking hard about putting patients at the centre of decision making about their data, and explains why she thinks a sole reliance on a consent model falls short.

Next, uncertain power supplies, such as in conflict or disaster zones, means uncertain refrigeration. Hard enough for most people to survive, but if you need to keep your insulin cold, it can be lifethreatening. However a new cochrane review has found good news about the thermostability of insulin at room temperature.

We ask Phillipa Boulle, MSF Intersectional NCD Working Group Leader and Cyrine Farhat,is a global diabetes advocate based in Lebanon, how this will affect care for patients around the world.

Reading list

Thermal stability and storage of human insulin

Outline

00:06 introduction and overview

00:24 the challenge of seeking consent in big data sets

01:34 understanding consent issues in large datasets

01:52 the role of participant panels in data accountability

02:44 the complexity of public attitudes towards data use

04:54 the importance of transparency and engagement in data use

05:48 the impact of external factors on public trust in data use

07:49 the ethical challenges of using health data

09:17 the limitations of consent in ethical discussions

09:23 the need for more conversation about group benefits, risks, and harms

10:41 the role of governance in ethical decision making

12:05 discussion on the interview with natalie banner

14:59 the challenge of managing chronic conditions in disaster zones

15:15 the impact of temperature and storage conditions on insulin

17:32 interview with Philippa Boulle from medecins sans frontieres

29:10 interview with Cyrine Farhat, a person living with diabetes in lebanon

36:18 discussion on the interviews and the challenges of diabetes management

We were accepting of an increase in deaths every winter 'flu season, but Ashish Jha thinks that is not longer a tenable position.

Lessons he learned during his time as the White House Covid-19 coordinator have convinced him we should be taking a different approach to the winter season.

In this interview with Mun-Keat Looi, The BMJ's international features editor, we hear about living with COVID, the future of antivirals, vaccines, and surveillance. They talk about long COVID, the investment required to fight future outbreaks effectively, and the role of the US in the global health response.

Each episode of Talk Evidence we take a dive into an issue or paper which is in the news, with a little help from some knowledgeable guests to help us to understand what it all means for clinical care, policy, or research.

In this episode:

Helen Macdonald take a deep dive into cancer screening tests, prompted by a paper in JAMA which showed most have no effect on all cause mortality, and news that the NHS is evaluating a single test which screens for 50 common cancers - we ask Barry Kramer, former director of the Division of Cancer Prevention, at the U.S. National Cancer Institute to help explain how to hold those two pieces of knowledge.

Juan Franco has been looking into diet and obesity, prompted by new research in The BMJ and a new Cochrane review, looking at the role of low glycemic index foods in weightloss - we ask Khadidja Chekima, nutritional researcher at Taylor’s University in Malaysia, to define low GI foods, and why it’s so hard to research their role in diet and weightloss

Reading list;

JAMA research - Estimated Lifetime Gained With Cancer Screening Tests; A Meta-Analysis of Randomized Clinical Trials

The BMJ news - Clinicians raise concerns over pilot of blood test for multiple cancers

The BMJ research - Association between changes in carbohydrate intake and long term weight changes: prospective cohort study

Cochrane review - Low glycaemic index or low glycaemic load diets for people with overweight or obesity

Organisational and student leaders explore the responsibilities of the British Medical Association and The BMJ to understand and respond to its colonial history.

Our panel

Kamran Abassi, editor in chief, The BMJ, London, UK
Omolara Akinnawonu, Foundation year doctor, Essex, UK, and outgoing co-chair of the BMA medical students committee
Latifa Patel, elected chair of the UK BMA's Representative Body and BMA EDI lead
Host - Navjoyt Ladher, clinical editor for The BMJ

Leaders from academic and funding organisations discuss the transformative change required to overcome extractive and inequitable research practices in global health, and the need for examining power and privilege within traditional research institutions.

Our panel

Samuel Oti, senior program specialist, International Development Research Centre, Ottawa, Canada, and member of the Global Health Decolonization Movement in Africa (GHDM-Africa)
Muneera Rasheed, clinical psychologist and behaviour scientist and former faculty, Aga Khan University, Karachi, Pakistan
Liam Smeeth, professor of clinical epidemiology and director of the London School of Hygiene and Tropical Medicine, London, UK
Angela Obasi, senior clinical lecturer, Liverpool School of Tropical Medicine, UK
Seye Abimbola, editor of BMJ Global Health, and health systems researcher from Nigeria currently based at the University of Sydney, Australia
Jocalyn Clark, international editor, The BMJ, London, UK
Host - Navjoyt Ladher, clinical editor for The BMJ

International health leaders discuss how feminist and decolonial advocates in health face similar resistance and attempts to sow divisiveness, and how they can join forces to promote health equity and justice for all.

Our panel

Raewyn Connell, sociologist and professor emerita at the University of Sydney, Australia
Sarah Hawkes, professor of global public health and director of the Centre for Gender and Global Health, University College London, UK
Sanjoy Bhattacharya, head of the school of history and professor of medical and global health histories, University of Leeds, UK
Asha George, professor and South African research chair in health systems, complexity, and social change, University of the Western Cape, South Africa
Host - Navjoyt Ladher, clinical editor for The BMJ

Experts discuss how failing to confront colonial pasts is linked to present lack of progress in global health equity, why health leaders need historical educations, and how, for Indigenous peoples, it’s not just a colonial history but a colonial present.

Our panel

Seye Abimbola, editor of BMJ Global Health, and health systems researcher from Nigeria currently based at the University of Sydney, Australia
Catherine Kyobutungi, Ugandan epidemiologist and executive director of the African Population and Health Research Center, Nairobi, Kenya
Sanjoy Bhattacharya, head of the school of history and professor of medical and global health histories, University of Leeds, UK
Chelsea Watego, professor of Indigenous Health at Queensland University of Technology, Australia
Host - Navjoyt Ladher, clinical editor for The BMJ

Healthcare leaders discuss the ways in which colonial-era bias and eugenics persist in today’s medical education and clinical practice in the UK and beyond, and what meaningful change is required to overcome racial and other healthcare inequalities

Our panel

Annabel Sowemimo, sexual and reproductive health registrar and part-time PhD student and Harold Moody Scholar at King’s College London, UK
Thirusha Naidu, head of clinical psychology, King Dinuzulu Hospital, and associate professor, Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
Subhadra Das, UK based researcher and storyteller who specialises in the history and philosophy of science, particularly scientific racism and eugenics
Amali Lokugamage, honorary associate professor, Institute of Women's Health, University College London, and consultant obstetrician and gynaecologist, Whittington Hospital, London, UK
Host - Richard Hurley, collections editor at The BMJ

We’ve heard throughout the series from people who have a passion for sustainability, and have successfully made changes in their organisations to reduce the planetary impact of their work. In doing so, they will have recruited other people who have a similar outlook - but they will have also convinced people who aren’t prioritising sustainability.

In this last podcast of the series, we’re delving into that - how to talk to colleagues and patients, in ways which connect with their own needs and preferences.

To help with that, we’re joined by David Pencheon, director of the Sustainable Development Unit for NHS England, who’s been successfully talking about these issues for years, and Kate Wylie, executive director of Doctors for the Environment Australia.

One element of sustainable healthcare is simply reducing the amount of healthcare you’re doing by not doing the things that are of no value to patients. However, how do we do this in practice? And why is it often so hard? What is the role of fear in this discussion? These are all questions we will discuss in this episode.

To help us with this we’ll be joined by Prof Ben Newell (cognitive psychologist from University of New South Wales, whose research interest includes judgement and decision making). and Dr Lucas Chartier, emergency medicine physician at the University Health Network in Toronto.

Ben Newell also has also recently released a book, Open Minded, co-authored with David Shanks on the role of the unconscious mind in our decisions making

Acting on climate change is often framed as having to give stuff up, to cost more money, to make sacrifices. Yet in healthcare we find the opposite can often be true: there are many actions we can take which reduce the carbon footprint of healthcare which actually end up with better outcomes for our patients. In this episode, we hear from two examples of that.

Singing for breathing is a type of social prescribing to help people with chronic lung disease manage their breathlessness, reducing their need to be reliant on healthcare to do this, while also finding joy and a sense of community. Stephen is one patient who has benefited from this service, and will tell us more about the impact it had on his life.

In another example, Lynn Riddell, an HIV consultant will tell us how a change in their clinical pathway helped a cohort of patients reduce the amount of travelling to and from the clinic, still manage their condition safely and give them back precious time and control.

https://www.bartscharity.org.uk/our-news/singing-sessions-to-improve-patients-lung-health/

Ooops! If you listened to episode 3 when it first came out you may have realised that the title didn't quite match the content. We've just updated the title and the show notes below, and stay tuned for when we'll be soon releasing an episode on how sustainable healthcare can be good for patients.

In a system where healthcare workers are continually described as overworked and burnt out, how can we expect them to find the time to act on the climate? In this episode we turn that assumption on its head, and, in fact, show how acting to reduce the environmental impact of healthcare can help staff find joy in their work again. Our two guests today are Tracy Lyons, founder of Pharmacy Declares and medicines optimisation pharmacist in Dorset, UK, and David Smith, general surgeon at North York General Hospital in Toronto, Canada.

The very worst thing is sometimes to have a problem you feel you can’t solve, and action mitigates anxiety: these are two of the many lessons that came out of today’s episode. We also touch on the different levels that you can start to take action at: from the small and tangible to influencing change at a system level.

Related links:

https://cascadescanada.ca/

https://www.pharmacydeclares.co.uk/

https://twitter.com/TLyons00

In this month's Talk Evidence, Helen and Juan are reporting from Preventing Overdiagnosis - the conference that raises issues of diagnostic accuracy, and asks if starting the process of medicalisation is always the right thing to do for patients.

In this episode, they talk about home testing, sustainability and screening. They're also joined by two guests to talk about the overdiagnosis of obesity - when that label is stigmatising and there seem to be few successful treatments that medicine can offer, and the need to educate students in the concepts of overdiagnosis and too much medicine, to create a culture change in medicine.

Links;

The Preventing Overdiagnosis conference

The BMJ EBM papers on choosing wisely.

Healthcare is a complex system, and if we want to make changes such as those needed for sustainable healthcare, we need to work across multiple teams, and make sure we hear everyone’s voice, including our patients’. In this episode we’ll discuss how we can communicate and work with those different groups, and some novel ways of getting the message across from T-rexes worth of plastic gloves to art made out of surgical waste.

Guests for this episode:

Nicola Wilson, lead clinical educator Great Ormond Street Children’s hospital and Maria Koijck, artist and former patient.

Read more about the Gloves are Off project, you can see Maria’s film here: https://www.mariakoijck.com/

Planet centred care is new podcast series for the BMJ exploring issues related to environmentally sustainable healthcare, aimed at all clinicians, and anyone working in healthcare, who want to make sure they can continue to help patients while not harming the planet.

In this episode we’ll discuss that first radicalising moment. That moment where you start to see all the things you can do to make healthcare more sustainable and how it is hard to un-see that. For everyone, that moment may come from a different place, or different perspective.

Our guests for this episode:

Gareth Murcutt who was at first reluctant until he saw the size of the impact he could make; Gwen Sims whose eyes were opened by moving health systems (and continents) and Alifia Chakera who didn’t expect to find a huge sustainability saving so close to home when she took up a new clinical role before the pandemic.

Hosts:

Loren De Freitas and Florence Wedmore, the BMJ

In our final episode of this season, we're going quantitative, with the newly released data on how trainees in the UK are faring.

Each year the UK's General Medical Council, the doctor's regulator, surveys trainees in the NHS to ask them questions about stress and burnout, harassment and discrimination, and how well supported they feel in their training. They also ask trainers about the same things.

Unsurprisingly, the year the results look bad - with increasing levels of burnout across the board, but particularly in new trainees. At the same time trainers are feeling unable to use their time supporting learning, and instead are propping up the system.

To discuss this, Clara Munro and Ayisha Ashmore are joined by Colin Melville, medical director, and director of education and standards, at the GMC.

All the data discussed, and the interactive tool that Colin mentions, are available on the GMC's National training survey 2023 results page.

In this month's Talk Evidence, we're getting a little meta - how do we keep an eye on research to make sure it's done with integrity. Helen Macdonald is BMJ's Publication ethics and content integrity editor - and we quiz her about what that actually means on a day to day basis.

Ensuring the integrity of research could be made both easier, and harder, by the ascendance of large language models, Ian Mulvaney, BMJ's chief technology officer joins us to talk about how we can harness the power of this new technology.

They're the trusted public figures of the medical profession, but many of the most famous medics in the UK will have been approached by, and accepted money from, companies wishing to promote their products - and the public will never know.

To talk about conflicts of interest in media doctors, we’re joined by two of the most recognisable medics on our screens - Chris and Xand van Tulleken, and the GP who persuaded them to think about what they receive cash for, Margaret McCartney.

Read our investigation into how the UK's medical royal colleges receive millions from drug and medical devices companies and Margaret McCartney's plea that “You have to be above reproach”: why doctors need to get better at managing their conflicts of interest

In this episode of Talk Evidence, Helen Macdonald, Joe Ross, and Juan Franco are back to update us on what's happening in the world of medical evidence.

Firstly, the news about the end of the covid-19 pandemic was trumpeted, but the changes to research funding have been more quite - and the team discuss what this means for ongoing work to understand the effects of covid, but also in terms of preparedness for the next pandemic.

Next, breast cancer screening recommendations, in the USA, have been reduced from women over the age of 50, to those over the age of 40. We discuss the modelling study which lead to that recommendation change, and what the consequence may be in terms of overdiagnosis.

Finally, 40 years ago, the U.S. Orphan Drug act was passed to encourage the development of treatments for rare conditions - but new research looks at how many clinically useful drugs have come onto market, and an analysis examines the way in which the system could be gamed by narrowing disease definitions to create small populations of patients.

Reading list

Is the UK losing its world leading covid surveillance network just when it needs it most?

Breast cancer: US recommends women start screening at 40

FDA approval, clinical trial evidence, efficacy, epidemiology, and price for non-orphan and ultra-rare, rare, and common orphan cancer drug indications

We're in pride month, and this year the celebration of LGBT+ people seems to be increasingly contentious. Healthcare's treatment of queer people has improved hugely since the days when being gay was considered a mental disorder, and would end a doctor's career - but that doesn't mean that everything is equal.

In this episode of Doctor Informed, we're hearing from two doctors who are out and proud at work, about what it's been like to be queer in medicine, and what good allyship looks like.

Our Guests

Michael Farqhuar is consultant in sleep medicine at the Evelina London Children's Hospital, he also helped set up the NHS Rainbow badge scheme.

Greta McLachlan is a general surgical trainee, and member of the Royal College of Surgeon's Pride in Surgery Forum

The culture which allows sexism to perpetuate in healthcare is no better illustrated than by The BMJ's investigation into sexual abuse in the NHS.

However, The BMJ are not the first organisation to highlight the problems - Surviving in Scrubs have been collating stories of sexism in healthcare, and making waves about the issues for a while.

In this episode of Doctor Informed, Clara Munro is joined by the founders of Surviving in Scrubs, to discuss their campaign, how to create a culture of zero tolerance for sexism at the ward level, and why they think sexism should be a professional issue.

Our guests;

Becky Cox is an academic GP researching domestic abuse and GP specialist in gynaecology in Oxford.

Chelcie Jewitt is an emergency medicine trainee in Liverpool.

Bron Biddle, founder of Ambulance Voices, and an employee in the ambulance service.

Links;

https://www.bmj.com/me-too-investigation

Previous Doctor Informed interview with Baroness Helena Kennedy

Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine.This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately?Reading list;Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312Surgical versus non-surgical treatment for sciaticahttps://www.bmj.com/content/381/bmj-2022-070730CONSORT Harms 2022 statement, explanation, and elaborationhttps://www.bmj.com/content/381/bmj-2022-073725Funders crack down on unpublished clinical trials—but is it enough?https://www.bmj.com/content/381/bmj.p840Communication of anticancer drug benefits and related uncertainties to patients and clinicianshttps://www.bmj.com/content/380/bmj-2022-073711

Everyone has coping mechanisms, but sometimes those ways of coping become problem behaviours - addictions.In this episode of Doctor Informed, we're focussing on how to spot the signs that you may be sliding into addiction, how to have conversations with friends and colleagues if you worry about their behaviour, and how seeking treatment is the best way to avoid GMC scrutiny.Joining Clara Munro are Liz Croton and Zaid Al-Najjar, GPs who work for NHS Practitioner health - a mental health and addiction service specifically for health professionals. They are also joined by Ruth Mayall, a retired consultant anaesthetist who has experienced addiction herself, and has contributed to the Association of Anaesthetists guidance on drug and alcohol abuse.Some resources mentioned in the podcast;NHS Practitioner Healthhttps://www.practitionerhealth.nhs.uk/The Sick Doctor's Trusthttp://sick-doctors-trust.co.uk/British Doctors & Dentists Grouphttps://www.bddg.org/Substance use disorder in the anaesthetisthttps://anaesthetists.org/Home/Resources-publications/Guidelines/Substance-use-disorder-in-the-anaesthetistSubstance abuse in anaesthetistshttps://academic.oup.com/bjaed/article/16/7/236/2196385?login=false

In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research, They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better.We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies.Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria.Reading listEstimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland https://www.bmj.com/content/380/bmj-2022-072098How can we improve the quality of data collected in general practice?https://www.bmj.com/content/380/bmj-2022-071950#UK to give “near automatic sign off” for treatments approved by “trusted” regulatorshttps://www.bmj.com/content/380/bmj.p633Smartphone apps for point-of-care information summarieshttps://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146

In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research, They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better.We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies.Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria.Reading listEstimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland https://www.bmj.com/content/380/bmj-2022-072098How can we improve the quality of data collected in general practice?https://www.bmj.com/content/380/bmj-2022-071950#UK to give “near automatic sign off” for treatments approved by “trusted” regulatorshttps://www.bmj.com/content/380/bmj.p633Smartphone apps for point-of-care information summarieshttps://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146

Fatigue can have as much of an affect in your ability to function as alcohol, and yet while you would be chastised for drinking before appearing on the ward, hospitals have systematically removed the spaces where tired clinicians can rest and recover.The Royal College of Anaesthetists have been campaigning to raise awareness of the dangers of fatigue, and it seems that anaesthetic trainees have benefitted from that, with sleep pods and flexible schedules - but other specialties are lagging behind.In this podcast, Roo McCrossan, a consultant anaesthetist joins our host Clara Munro, a surgical trainee, and Ayesha Ashmore, obstetric trainee, to talk about how to fight fatigue. They discuss circadian rhythms, what to eat, nappuccinos, and why trusts should make more sleeping spaces.For more information about fighting fatigue;https://anaesthetists.org/Home/Wellbeing-support/Fatigue/-Fight-Fatigue-download-our-information-packs

We're bringing you an episode of the BMJ's podcast for primary care, Deep Breath In, which we think you'll enjoy.How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system; but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time.A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” - and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations.In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do.Reading list:Guidelines should consider clinicians’ time needed to treathttps://www.bmj.com/content/380/bmj-2022-072953

As workforce gaps in the NHS, and other healthcare systems around the world widen, the need to improve staff retention has become an ever more pressing concern. Yet work-life balance issues continue to drive staff away from the service.What is the imperative to get flexible working right, and what can be done to remove the barriers facing healthcare workers seeking to change the way they work?Joining us in the discussion are;Kamran Abbasi, editor in chief of The BMJRachel Hutchings, fellow at the Nuffield TrustSarah Sweeney, interim chief executive, National VoicesFarzana Hussain, a GP in Newham, LondonThea Stein, chief executive of Leeds Community Healthcare NHS TrustThe report that Rachel Hutchings has authors is summaried in a BMJ feature - Challenges of combining a career in surgery with parenting https://www.bmj.com/content/380/bmj.p449

In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ.First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help. Joe finds new research on the link between six healthy lifestyle markers and cognitive decline. Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI.Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses. Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it Reading list:Efficacy, safety, and tolerability of antidepressants for pain in adultshttps://www.bmj.com/content/380/bmj-2022-072415Association between healthy lifestyle and memory decline in older adultshttps://www.bmj.com/content/380/bmj-2022-072691Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults https://www.bmj.com/content/380/bmj-2022-072319Physical interventions to interrupt or reduce the spread of respiratory viruseshttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/fullHealth and nutrition claims for infant formulahttps://www.bmj.com/content/380/bmj-2022-071075

In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ.First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help. Joe finds new research on the link between six healthy lifestyle markers and cognitive decline. Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI.Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses. Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it Reading list:Efficacy, safety, and tolerability of antidepressants for pain in adultshttps://www.bmj.com/content/380/bmj-2022-072415Association between healthy lifestyle and memory decline in older adultshttps://www.bmj.com/content/380/bmj-2022-072691Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults https://www.bmj.com/content/380/bmj-2022-072319Physical interventions to interrupt or reduce the spread of respiratory viruseshttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/fullHealth and nutrition claims for infant formulahttps://www.bmj.com/content/380/bmj-2022-071075

Grit is one of those concepts (like the dreaded resilience) that has a specific meaning, but has become a buzzword in healthcare.It’s the ability to persevere in the pursuit of a goal, in the face of obstacles - and it’s something all doctors have. However that trait has benefits and drawbacks. It’s not necessarily fixed, but will depend on context, and it is measurable but not a very helpful measure in isolation.In this episode, Clara Munro is joined by Declan Murphy and Ayisha Ashmore - and they sit down with neurourgeon and researcher Simone Betchen, who has measured grit in women surgeons, and helps them understand their grit scores.Reading listGrit in surgeonshttps://pubmed.ncbi.nlm.nih.gov/34218313/

Claire Mulrenan, specialist registrar in public health, and Mark Petticrew, professor of public health evaluation, both working at the London School of Hygiene and Tropical medicine were surprised to see high-fat, high-salt fast food brands being featured heavily on the website of one of the UK's most beloved children's comics.In this podcast, they describe why they think that is harmful, and why the Beano should think again about its editorial policies, to protect children's health.To read the full investigation: www.bmj.com/content/380/bmj.p197

In this week's episode, we're focusing on covid and the ongoing crisis in the NHS.Helen Macdonald, Juan Franco and Joseph Ross cast their evidence seeking eyes over research into outcomes as well as the workload of doctors.Firstly, Joe tells us about a new big data study into longer term outcomes after mild covid-19, how those ongoing symptoms relate to long covid, and how often they resolve themselves.Juan looks back to his homeland to see what Argentina which was very early to offer children vaccinations against covid-19. He tells us how a new study design can help understand how effective different combinations of vaccines were.Joe has a Danish registry paper, which links people's employment status after a MI, explains how that gives us an insight into morbidity following that event.Helen looks at a new analysis which outlines the concept of "time needed to treat" - a measure of how much time it would take a clinician to actually carry out a guideline - and you'd be surprised how much GP time would be swallowed by a "brief" intervention to reduce inactivity in their patients.Finally, the data on excess mortality in the UK has been up for debate recently - our health minister calling into question the Office of National Statistic's data. We hear from Nazrul Islam, Associate professor of medical statistics, advisor to the ONS and BMJ research editor, who has some bad news for him.Reading list:Long covid outcomes at one year after mild SARS-CoV-2 infectionhttps://www.bmj.com/content/380/bmj-2022-072529Effectiveness of mRNA-1273, BNT162b2, and BBIBP-CorV vaccines against infection and mortality in children in Argentina, during predominance of delta and omicron covid-19 variantshttps://www.bmj.com/content/379/bmj-2022-073070Guidelines should consider clinicians’ time needed to treathttps://www.bmj.com/content/380/bmj-2022-072953Expanding the measurement of overdiagnosis in the context of disease precursors and risk factorshttps://ebm.bmj.com/content/early/2023/01/10/bmjebm-2022-112117Excess deaths associated with covid-19 pandemic in 2020https://www.bmj.com/content/373/bmj.n1137.abstract

One size doesn’t fit all - so what are the alternative career paths of doctors in the NHS? The treadmill of medical school, to foundation training, to specialist training, to a consultant position takes years and is not very trainee-centric in it’s design.So are there other ways for doctors to be able to work in the NHS, still progress their career, but also tailor the job to themselves? And what are the drawbacks of trying to do that?In this podcast, Clara Munro is joined by Flo Wedmore and new panelist Jason Ramsingh, a surgical trainee in Newcastle. They speak to Rob Fleming an SAS (speciality and associate specialist) doctor in anaesthetics.

As we gear up for the winter in the northern hemisphere, the need to stay warm and eat well is pressing - but in 2022, there are global pressures working against us. Russia invaded Ukraine, and the subsequent restrictions on exports from both of those countries is being felt in terms of fuel costs - but also food costs. At the same time, this year has seen droughts and flooding which have affected global food production, as well as continuing restrictions around covid and economic activity. All of these factors are working together to increase food insecurity.Our Guests;Sheryl Hendricks, professor of food security at the University of PretoriaRenzo Guinto, chief planetary doctor at PH LabTim Benton, director of the Environment and Society Programme at Chatham House.

It's almost time for the Christmas edition of the BMJ to hit your doormats, and in this festive edition of Talk Evidence we're going to be talking Christmas research.Joining Helen and Juan, we have Tim Feeny, BMJ research editor and researcher into Surgical outcomes at Boston University.In this episode we'll be hearing about the health of footballers, and if a career in the sport predisposes Swedish players to substance use disorders. We'll hear about the performance of BMJ’s editors, when it comes to assessing the impact of a paper. We'll find out if AI algorithms can pass UK radiology exams, misinformation and a belief that everything causes cancer, and finally, some tips from BMJ’s statisticians to set the world right

In this episode of the Dr. Informed podcast, the topic of discussion is death and dying, and how to speak to patient's about DNACPR orders.The panel discuss the importance of doctors having discussions with patients about end-of-life care as a way of creating the best possible death for patients. The conversation also touches on the challenges that doctors may face when having these difficult discussions and they give some advice on how they to overcome them.Joining Clara are;Mark Taubert, palliative care consultant, and national chair of future care planning for the Welsh GovernmentKat Shelley, an anaesthetics trainee, who has stage four breast cancer, and is receiving palliative careLucy-Anne Frank, an elderly care consultant.The article "Do not resuscitate me in Barbados" is published by BMJ Supportive and Palliative Care, and is free to access at;https://spcare.bmj.com/content/11/3/310

In this month's episode, Helen Juan and Joe delve into the clinical - with a new review of endometriosis, and why the difficulty in diagnosis has lead to a dearth of evidence and attention on the condition.Joe tells us about a risk prediction tool that could be useful in helping to mitigate some of the problems of antihypertensive treatments.We're also having a geek out about a group of papers we've published lately, on how well evidence is created, maintained, and diseminated.Reading list;Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort studyhttps://www.bmj.com/content/379/bmj-2022-070918Pathophysiology, diagnosis, and management of endometriosishttps://www.bmj.com/content/379/bmj-2022-070750Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidencehttps://www.bmj.com/content/379/bmj-2022-070195Consistency of covid-19 trial preprints with published reports and impact for decision making: retrospective review https://bmjmedicine.bmj.com/content/1/1/e000309Changing patterns in reporting and sharing of review data in systematic reviews with meta-analysis of the effects of interventions: a meta-research study from the REPRISE projecthttps://www.medrxiv.org/content/10.1101/2022.04.11.22273688v2

MedTwitter consists of an online community of researchers, health practitioners and students who have created an open source decentralised forum for information sharing, medical education and professional networking. #MedTwitter also provides a space for publications to be shared and promoted. While many will credit Twitter with giving a voice to clinicians, it also comes with challenges, the potential for abuse, or the spread of misinformation.

Joining Clara to discuss are;

Jonathan Guckian, a dermatology registrar in Leeds, and director of social media and communications at the Association for the Study of Medical Education (ASMI).

Flo Wedmore, a medical registrar and NHS sustainability fellow

Declan Murphy, an academic medical fellow S2 in ophthalmology in Newcastle, and former Sharp Scratch panelist.

Last month, saw the WISH 2022 - the World Innovation Summit for Health, where experts from around the world came and presented their ideas.

In this podcast we'll hear from Dame Sally Davies, the UK’s Special Envoy on Antimicrobial Resistance - she explains how covid, and treatment uncertainty, put paid to conservative prescribing; and what innovations in microbial treatment are on the horizon.

Following that, James Campbell, director of the health workforce department at the WHO, who joins us to talk about new data they have on the wellbeing, and why the international market for healthcare staff is no longer the simple solution for vacancies.

The BMJ's collections we mentioned are on empowering and engaging patients (https://www.bmj.com/empowering-and-engaging-patients) and food security and health in a changing environment (https://www.bmj.com/food-security-and-health-in-a-changing-environment)

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor.

They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening.

We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query.

We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments.

Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work.

Reading list

Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

Emulating the GRADE trial using real world data: retrospective comparative effectiveness study https://www.bmj.com/content/379/bmj-2022-070717

Expression of concern about content of which Dr Paul McCrory is a single author https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc

In this episode of Doctor Informed, we're talking sustainability. The BMJ has a special edition on the climate crisis, and finding hope amid dispair - and we want to help our listeners with some of that. Clara is joined by three of the NHS's sustainability fellows, Florence, Who is a medical registrar, Emily a paedatrics trainee, and Leigh, an anaesthetics trainee

For more on the climate crisis, read The BMJ's special edition https://www.bmj.com/content/379/8356

It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid.

Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic.

Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes

Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - oncology, and some interesting insights into clearance margins in cancer surgery.

Reading list

Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period https://www.bmj.com/content/378/bmj-2022-071215

Guided by the science? Questions for the UK’s covid-19 public inquiry https://www.bmj.com/content/378/bmj.o2066

Associations of physician burnout with career engagement and quality of patient care https://www.bmj.com/content/378/bmj-2022-070442

Margin status and survival outcomes after breast cancer conservation surgery https://www.bmj.com/content/378/bmj-2022-070346

It's zoomers vs boomers on this week's Doctor Informed, as we assemble a multigenerational team to talk about the "good old days" and if the youth of today are really snowflakes.

Clara Munro is joined by Nikki Nabavi, a medical student at Manchester University and a regular on Sharp Scratch (The BMJ's student podcast); Ayisha Ashmoore, an trainee in obstetrics and gynaecology, in the East Midlands; and Alastair Munro, a retired professor of oncology (and Clara's dad).

In our new season of Doctor Important, we'll be discussing topics that are not always talked about, and today, by popular request of our listners, we're talking about Coroner's Court and inquests - two things that strike terror into doctors, but are often not as bad as you may fear.

Our panel; Clara Munro is a surgical trainee in the North East Deanery. She's joined by her colleage Katie Strong, another surgical trainee. We also have returning to Doctor Informed Ayisha Ashmore, an Obs and Gynae registrar in the East Midlands.

Our Expert guest this week is Beth Walker, a former palliative care registrar who now works as an advisor for Medical Protection.

This is our last episode of series 1 of Doctor Informed, and with it we're coming full circle. Clara will be talking to our first two guests, Mary Dixon-Woods and Bill Kirkup, having now heard from all of our other experts over this series.

In this first series, we've learned about speaking out, team work, compassionate leadership - all the things that are needed to help clinicians challenge the status quo, So in this episode, we'll be asking Mary how much she thinks things have changed, and Bill how he manages a career challenging the healthcare system.

Our guests

Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.

For links to the work that Mary talked about visit https://www.thisinstitute.cam.ac.uk/

Bill Kirkup is a clinician turned investigator - he led investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel

In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat.

They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now.

We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs.

And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox.

Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis https://www.bmj.com/content/378/bmj-2021-067606)

Using individual participant data to improve network meta-analysis projects https://ebm.bmj.com/content/early/2022/08/10/bmjebm-2022-111931

Industry sponsorship bias in cost effectiveness analysis: registry based analysis https://www.bmj.com/content/377/bmj-2021-069573

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak https://www.bmj.com/content/378/bmj-2022-072410

Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada: https://www.bmj.com/content/378/bmj-2022-071502

Previous Doctor Informed episodes have discussed how to prevent patient safety issues from occurring, but sometimes situations are beyond anyone's control - like covid.

Hhow should individual doctors, and the hospital system, respond to those crises? Especially when it can be hard to look back at things we know have gone wrong, and could be critical of the way we responded.

In this episode, we're joined by Annelieke Dresden, a medical anthropologist at the London School of Hygiene and Tropical Medicine, who has spent hours listening to patient experiences of ICU during the covid pandemic. We'll also be hearing from Dominque Allwood, medical director at UCL Partners, and Deputy Director of Strategy and Improvement at Imperial College Healthcare NHS Trust, and asking; are doctors always the right ones to be leading on changing things in healthcare?

The research Annelieke Drissen discussed, and the full versions of the patient interviews in the podcast are available at https://healthtalk.org/Experiences-of-Covid-19-and-Intensive-Care/overview

In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence.

Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together.

We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits.

In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now.

Reading list: Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653

Serious adverse event rates and reoperation after arthroscopic shoulder surgery https://www.bmj.com/content/378/bmj-2021-069901

Viscosupplementation for knee osteoarthritis https://www.bmj.com/content/378/bmj-2022-069722

Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose https://www.bmj.com/content/378/bmj-2022-071249

As the Russian invasion of Ukraine continues, living under the uncertainty has become the new normal for thousands of patients with diabetes who are dependant on insulin.

Supporting patients with non-communicable disease is the reality of all disaster situations now, and that added layer of complexity makes coordinating responses even harder.

In this podcast, we'll hear how people with diabetes are being supported in Ukraine, and what is being done to improve things, despite the continued fighting.

Our guests; Iryna Vlasenko, Vice President of the International Diabetes Federation Slim Slama, unit head for NCD management at the WHO Yaroslav Diakunchak, family physician in Brovary, Kyiv.

In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM.

They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue. https://www.bmj.com/content/377/bmj-2021-069719

Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests. https://www.bmj.com/content/377/bmj-2021-068776

They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease. https://www.bmj.com/content/377/bmj-2021-067085

Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis. https://www.bmj.com/content/377/bmj-2022-069989

Finally, they find out how your political persuasion has affected mortality in the US, with new research that links Republican and Democrat voters with differential changes in mortality. https://www.bmj.com/content/377/bmj-2021-069308

A recent investigation, by The BMJ, showed a worrying increase in incidence of violence, directed to wards GPs, and reported to the police. In this episode of Deep Breath in, Tom and Jenny are joined by Gareth Iacobucci, assistant news editor for The BMJ who broke the story.

They'll hear from a GP affected, and get some advice on preventing violence, and deescalation, from two mental health experts, who deal with the most agitated patients.

Our guests: Adam Janjua, a GP in Fleetwood, Lancashire. Marcela Schilderman, a consultant psychiatrist at South London and the Maudsley NHS Foundation Trust and Anita Bignell, a mental health nurse, at South London and the Maudsley NHS Foundation Trust

Reading list Violent incidents at GP surgeries double in five years, BMJ investigation finds https://www.bmj.com/content/377/bmj.o1333

In Doctor Informed, we've been hearing a lot about the problems of healthcare, but we also want to talk about solutions. Whatever we're going to do to fix healthcare, whether that's bullying, or burnout, or patient safety - it's going to require change. And change is hard.

In this episode Clara Munro is joined by Graham Martin, director of research at THIS Institute. They discuss the dreaded phrase "But it's always been done this way", and why failing is the path to success, and the true importance of listening.

Our guests;

Penny Pereira, Q managing director at the Health Foundation. Q helps promote improvement within the health and care system, encouraging and supporting a wide range of people to effectively lead improvement. https://www.health.org.uk/about-the-health-foundation/our-people/q-and-q-labs-team

Moira Durbridge, director of safety and risk at University Hospitals of Leicester NHS Trust. Moira trained as a nurse, and continues to work clinically, as well as her role in leading her Trust's change.

Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires

In this episode they discuss;

The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate.

We'll give you a quick update on treatment for Covid-19

We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer?

And finally, treatment variation - it's one of the things that helped kick-start the EBM revolution, but there's still much to learn. Juan describes some new research which examines how countries stack up when you compare their handling of and outcomes of a common condition such as a myocardial infarction.

Reading list;

Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade https://www.nejm.org/doi/full/10.1056/NEJMp2206246.

A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379

Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19 https://www.bmj.com/content/377/bmj-2021-069400

Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries https://www.bmj.com/content/377/bmj-2021-069164

The influence of public health on politics, at least at the beginning of the pandemic, had never been stronger - but now it seems as hard to persuade politicians to pay attention as ever, yet political will is essential in making different sectors work together to create a healthier world.

In this podcast, The BMJ's editor in chief, Kamran Abbasi is joined by Shyama Kuruvilla, senior strategic adviser at World Health Organization, and Kent Buse, director of the global healthier societies program at The George Institute for Global Health.

They discuss examples of where multisectoral working has managed to bridge the gaps between sectors, and how healthcare needs to get political to make that success more widespread.

This is part of the collection "The world we want: Actions towards a sustainable, fairer and healthier society" - https://www.bmj.com/pmac-2022

This is a special episode of our podcast for GP's, Deep Breath In, where we tackle the everyday challenges of being a GP.

With the focus on covid, and the pressure on hospitals, it may be easy to overlook what’s happening in general practice in the UK - but changes are afoot. Our new health secretary Sajid Javid doesn’t seem to like our long standing GP practice arrangement, NHS England has imposed new weekend working arrangements on the already stretched service, and the workforce pressures continue.

In this episode of Deep Breath In, our GP panel of Tom Nolan, Navjoyt Ladher, and Jenny Rasanathan are joined by Gareth Iacobucci, The BMJ’s assistant news editor, to give them the lowdown on what’s happening around primary care, who some of the key players are, and what his predictions for 2022.

You can find Deep Breath In on all major podcast apps https://www.bmj.com/podcasts/deepbreathin

Paula Redmond, clinical psychologist who supports healthcare workers experiencing burnout and other difficulties related to their job. Before this, she worked for the NHS until she experienced bullying, and a lack of support from her organisation, which made her strike out on her own.

In this wellbeing podcast, she describes the way in which her experience of bullying affected her, and how she used the creative process to help her move on.

She and Cat Chatfield discuss what creativity actually is, and why small projects can be just as useful as big complex ones - depending upon what you need at the time.

Futher reading: a Blog series on bullying in healthcare: https://drpaularedmond.com/category/bullying_in_healthcare/page/2/ a mindful embroidery craftivism project ("Do no harm but take no shit") https://drpaularedmond.com/donoharm/

Over the course of the last few years, the BMJ has published a series of articles in our Quality Improvement series - aiming to give those new to improvement science a good grasp of how to think about changing things in healthcare.

Then covid-19 came along, and it seemed like all of healthcare was now aimed at just surviving in the face of the pandemic, and all thoughts of quality improvement projects went out the window... But did they?

Cat Chatfield, is joined by Will Warburton, former director of quality improvement at the Health Foundation, and advisor on the series.

To read all of the open access articles mentioned in the discussion, visit https://www.bmj.com/quality-improvement

In this episode we’re going to be talking about misogyny in surgery, recent revelations about sexual harassment in the theatre have emerged - but these behaviours have been endemic for a while, even as the profession seemed to ignore them.

Joining Clara Munro is Baroness Helena Kenned, the author of a recent report into diversity in medicine, who, as a barrister, has long worked on discrimination cases.

The reports mentioned in the episode are from the Royal College of Surgeons;

https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review-2021/

In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence.

Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events https://www.bmj.com/content/376/bmj-2021-068373

Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women https://www.bmj.com/content/376/bmj-2021-0068229

Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult. Marginalized identities, mistreatment, discrimination, and burnout among US medical students https://www.bmj.com/content/376/bmj-2021-065984

The issue of food on nightshifts is a perennial grumble in the NHS, and though it might seem trivial, what does it say of an organisation if they demand their staff work when they're hungry, and what is the onward implication for that on patient care?

To discuss all of these issues, we're joined by Neely Mozawala, a community specialist diabetes podiatrist, and Sahlia Saliha Mahmood-Ahmed, a gastroenterologist who have started the #24hrhotfoodfortheNHS campaign.

Medicine is complex, and as a doctor you won't always do the right thing - but you can prepare yourself for when mistakes happen, both emotionally and logistically.

In this episode of Doctor Informed, Clara Munro is joined by Susanna Stamford, a patient who was on the receiving end of a mistake, which catalysed her interest in patient safety. We're also joined by Anthea Martin, from Medical Protection, who dispels some myths about saying sorry. Ayisha Ashmore returns to the pod to digest the lessons from our experts.

Futher reading: The video that Susanna mentioned is available to watch on youtube bitly.com/ManagingAdverseEvents

The covid-19 pandemic has stretched healthcare staff like never before. As part of the 2022 Nuffield Trust summit, The BMJ hosted a roundtable discussion looking at why workers leave the NHS and how staff wellbeing and retention can be improved.

Joining us to discuss are: Kamran Abbasi, editor in chief, The BMJ Billy Palmer, senior fellow, Nuffield Trust Lucina Rolewicz, researcher, Nuffield Trust Mark Britnell, global healthcare expert and senior partner, KPMG International Neil Greenburg, consultant occupational and forensic psychiatrist, King's College London's centre for military health research Rose Penfold, National Institute for Clinical Research academic clinical fellow in geriatrics Rammya Mathew, GP and quality improvement lead for Islington GP Federation Partha Kar, diabetes consultant and NHS England's national advisor for diabetes Danny Mortimer, chief executive of NHS Employers

The Nuffield Trust report, "The Long Goodbye" which was discussed in this roundtable is available here - https://www.nuffieldtrust.org.uk/resource/the-long-goodbye-exploring-rates-of-staff-leaving-the-nhs-and-social-care

In this episode of the podcast we’re going to be talking about rural healthcare - and specifically the difficulties that distance, demographics, and funding have introduced into the world’s covid-19 response.

Rural regions made vulnerable by limited healthcare infrastructure, lower rates of vaccination, and opposition to government policies are the new frontlines in the pandemic, but support systems have not adjusted to the growing rural needs for health education, testing, vaccination, and treatment.

Michael Forster Rothbart, Kata Karáth, and Lungelo Ndhlovu report from the US, Ecuador, and Zimbabwe

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, but the culture in your organisation might not always make that easy, especially if you feel something has gone wrong and you might be blamed for it.

Blame culture, no blame culture, just culture - there are many terms which are used to describe the environment in which individuals and teams work, the feel within a team and an organisation. In this episode we'll explore what they mean, why blame can be detrimental to patient safety, and give some tips on how to investigate problems without throwing blame around.

Our guests in this episode;

Joselle Wright - Deputy Director of Midwifery, Gynaecology and Sexual Health at Walsall Healthcare NHS Trust

Susanna Stanford, who became involved in patient safety after experience of a spinal anaesthetic failing during a c-section in 2010. She is an ambassador for the Clinical Human Factors Group.

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, and how to do that better, but as you progress through your medical career, you will become the person to whom those with problems will turn.

In this episode we will explore listening. As a senior clinician, how can you make the space in your work to be a good listener, when what you hear might not be what you want to hear?

Our guests; Megan Reitz is a professor of Leadership and Dialogue at Hult Business School. John Higgins is research director at The Right Conversation.

Reading Speaking truth to power: why leaders cannot hear what they need to hear https://bmjleader.bmj.com/content/5/4/270

In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate.

Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now.

Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that.

Reading list: Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1.full.pdf

Covid-19 vaccines and treatments: we must have raw data, now https://www.bmj.com/content/376/bmj.o102

WHO report: Climate change and health https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study https://www.bmj.com/content/375/bmj-2021-065653

Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study https://www.bmj.com/content/374/bmj.n1954

Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis https://www.bmj.com/content/374/bmj.n1904

In the previous episodes of Doctor Informed, we've heard why it's so important to talk about patient safety concerns, and some of the mechanisms that allow hospital staff to raise them, but knowing why and how doesn't always make it easier to speak out.

In this episode we're exploring the concept of a voiceable concern – identifying what counts as a concern, and what counts as an occasion for voice by an individual, is not a straightforward matter of applying objective criteria- for example how do you tell if you're witnessing poor practice, or just something that lies outside your area of understanding? Or how do you know if the common practice in this particular ward is actually an outlier when looking at other hospitals?

Our guests this week; Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.

Zoe Fritz is a consultant in acute medicine at Cambridge University Hospitals NHS Foundation Trust, she is also a Wellcome Fellow in society and ethics at THIS Institute, investigating how we communicate and record uncertainty around diagnosis.

Reading: https://pubmed.ncbi.nlm.nih.gov/34978470/

www.bmj.com/podcasts/doctorinformed/ https://www.thisinstitute.cam.ac.uk/podcast/

Rachel Levine Trained as a paediatrician, before becoming firstly the state of Pennsylvania's Physician General, then its Health Secretary.

During president Joe Biden's administration, she was nominated to become the U.S.'s assistant secretary of health. That lead to her becoming a four-star admiral in the U.S. Public Health Service Commissioned Corps, and thus the first openly transgender four-star officer in the US.

In this podcast, we discussed the pandemic - but also wider problems affecting Americans' health, notably climate change, inequality and the opioid crisis. We also discuss the health and care of LGBT+ people, in the U.S, and around the world.

This interview was recorded on the 16th of December 2021.

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think.

In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine.

They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.

As clinicians, we're all taught that patient safety is everyone's responsibility - but on the ground it can be hard to know how to most effectively report concerns, especially if you're not sure how those concerns will be received.

In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore, and they ask "who is actually responsible for patient safety?"

To answer that we're joined by 2 guests

Bill Kirkup, independent investigator who has worked on the reports into failings in Mid-Staffordshire, and Gosport.

Henrietta Hughes - GP, and the NHS's first guardian, Henrietta championed the creation of freedom-to-speak-up guardians in the English NHS, to ensure that clinicians are able to freely speak out.

Fiona Godlee is stepping down as Editor-in-Chief of The BMJ after 16 years in the position.

She was the first female editor of the journal, and over her tenure has seen a lot of changes - both to the publication she's run, and to the wider world of medicine.

To mark her departure, Helen Macdonald sat down with Fiona to ask her a bit about those early days at the journal, on her view of women taking leadership roles in medicine, on her thoughts about some of the big issues facing science, and what is coming next.

Note from the editor; apologies for the audio quality in the first half.

In this second podcast focussing on the covid response in South Asia, we’re focussing on the intersection of conflict and covid in the region. The pandemic has highlighted the underlying weaknesses in many health systems - but could it also be used as a catalyst for change, and be a step towards easing tensions?

To discuss this, Kamran Abbasi, executive editor of The BMJ, is joined by Zulfiqar Bhutta, head of the Institute for Global Health and Development, Aga Khan University, and Arun Mitra senior vice president of Indian Doctors for Peace & Development.

To read more; Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement? https://www.bmj.com/content/375/BMJ-2021-067384

In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore - and they're getting to grips with being a compassionate colleague.

While the topic might seem warm and fuzzy, there's some good hard science to suggest that compassionate leadership at every level of healthcare can make a huge difference to staff, and improve patient outcomes.

Most people innately have the skills need to be compassionate colleagues - but often the pressures of the job can make it the lowest of priorities in our everyday interactions.

Our two guests this week think that's wrong though - and say that compassionate leadership is one of the most important things to get right.

Joining us are, Michael West, senior fellow at The King's Fund and professor of Work and Organisational Psychology at Lancaster, and Bob Klaber, consultant general paediatrician and director of strategy, research and innovation at Imperial College Healthcare NHS Trust

Michael has written the book on compassionate leadership in health and social care - https://tinyurl.com/vh55mker.

You can read more about Bob's work in his blog - https://www.imperial.nhs.uk/about-us/blog/how-acts-of-kindness-can-improve-care-and-strengthen-teams

Ayisha has written about putting some of this all into practice in a maternity setting - https://bmjleader.bmj.com/content/early/2021/11/25/leader-2021-000449

In the wellbeing podcast, the dread topic of phone usage has come up again - how social media, and an "always on" culture can affect our wellbeing.

But knowing that, and changing our behaviour are two different things - so to give some advice on reducing our reliance on phones, Abi and Cat are joined by Nidhi Gupta, assistant professor of pediatrics at Vanderbilt University Medical Center, who's been using techniques from behavioural addiction to help with device usage.

For more from Nidhi, visit https://phreedom.net/

Some of the research that Nidhi mentions https://publications.aap.org/pediatrics/article/138/5/e20162591/60503/Media-and-Young-Minds

A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children https://pubmed.ncbi.nlm.nih.gov/18316661/

Distraction: an assessment of smartphone usage in health care work settings https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/

Treatment Considerations in Internet and Video Game Addiction https://pubmed.ncbi.nlm.nih.gov/29502754/

The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083558

When you hear the reports from a major patient safety issue, it will be shocking to hear how they have played out - but the patterns in behaviour, of people and institutions which have gone disastrously wrong, can be seen throughout healthcare.

As this first series of Doctor Informed unfolds, we'll be exploring these patterns, and bring you evidence and expertise on tackling them - Doctor Informed is about going beyond medical knowledge to make you the best doctor you can be.

In this first episode we're talking to experts who have seen these patterns firsthand, and whose work is all about tackling them;

Bill Kirkup is a clinician turned investigator - he ed investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel

Mary Dixon-Woods is director of THIS Insitute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.

In this month’s Talk evidence, we’re going back to our roots and avoiding covid - so sit back and listen to Helen Macdonald and Joe Ross discuss a new nutrition study to prevent fractures in older adults by eating dairy, and a meta-analysis which helps you choose pain relief medications for management of osteoarthritis.

We’ll hear from Steven Woloshin about the virtual Overdiagnosis conference, and why he’s so excited about a new category in the National Library of Medicine.

Finally, we have a study on urinary retention and risk of cancer that has been over 25 years in the making.

Reading list;

Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care https://www.bmj.com/content/375/bmj.n2364

Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis https://www.bmj.com/content/375/bmj.n2321

To access the webinars Steven was talking about. https://www.preventingoverdiagnosis.net/

Acute urinary retention and risk of cancer https://www.bmj.com/content/375/bmj.n2305

Podcast listener survey. Please let us know how we could improve the podcasts for you, and your specialty - https://linktr.ee/BMJsurvey

Doctor Informed is a new podcast for hospital doctors, from The BMJ - created in collaboration with THIS Institute, and sponsored by Medical Protection.

Medical expertise is fundamental to the practice of medicine. But other skills and knowledge are important too. Doctor Informed gives the inside story on the evidence about giving the best care and having positive relationships with patients and colleagues.

In this trailer, meet two of the hosts of Doctor Informed - Clara Munro, a surgical trainee in the North East Deanery, and Jenni Burt, senior social scientist at THIS Institute.

www.bmj.com/podcasts/doctorinformed

It's easy to decide to do something like exercise, or a hobby to improve your wellbeing, but actually following through and make that a regular part of your week can be much harder.

In this podcast, Pedro Delgado, vice president of the Institute for Healthcare Improvement, joins Abi and Cat to explain how he turned some of the QI methodology he's been taught over the years on himself, and improved his wellbeing during the pandemic.

www.bmj.com/wellbeing

In this podcast series, Kamran Abbasi, executive editor of The BMJ will convene experts from South Asia to discuss how the pandemic has affected the region, how measures like lock-down and vaccination have been handled, and the impact of the pandemic on the social determinants of health.

In this first podcast, we're focussing on India and Nepal, and are joined by;

Srinath Reddy, president of the Public Health Foundation of India.

Biraj Swain, who works in global development in Asia and East Africa, is a senior media critic

and Buddha Basnyat, director of the Oxford University Clinical Research Unit in Nepal.

For more covid coverage

www.bmj.com/coronavirus

This week our regular panelists, Helen Macdonald and Joe Ross, are joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine - to take a primary care focussed look at what's been happening in the world of evidence.

On this week’s episode. As kids go back to school, winter bugs surge and pressure mounts on health services we look at two trials which aimed to use reduce antibiotic prescribing for respiratory tract infections in nursing homes and primary care

Juan brings us an update on prescribing medicinal cannabis for pain, based on a recent BMJ rapid recommendation article and linked systematic review and meta-analysis

And finally, in covid news, how likely are you to be admitted or die from covid after one or two SARS-CoV 2 vaccinations?

Reading list Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents - https://www.bmj.com/content/374/bmj.n2198

Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care - https://www.bmj.com/content/374/bmj.n2132

Medical cannabis or cannabinoids for chronic pain - https://www.bmj.com/content/374/bmj.n2040

Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination - https://www.bmj.com/content/374/bmj.n2244

There has been a lot of work on the way in which surgeon's are affected by tiredness - and the whole medical workforce can probably relate to their experience.

But there's a difference between tiredness and fatigue, and that difference might be important in understanding what's happening in your own life.

Dale Whelehan is a physiotherapist, and PhD candidate at Trinity college Dublin, where he is investigating behavioural psychology and the effect of tiredness and fatigue on surgeons - in this podcast he describes how he thinks about those two things, what we know about the effect on wellbeing, and some strategies which might help manage them.

The infrastructure of Afghanistan healthcare is under threat, as international agencies who run clinics withdraw from the country. At the same time, some of the healthcare workforce are leaving the country, while those who remain face the prospect of their wages drying up as the economy of the country collapses.

But there remain people dedicated to providing healthcare, and in this podcast we hear from, Wais Mohammad Qarani, president of the Afghanistan Midwifery and Nurses Council, about what changes might be seen under the new regime, and what needs to be done to support care in the country.

The final evacuation planes have left Kabul airport, and Afghanistan’s government have ceded power to the Taliban.

Amongst the international community, worries about what that transition of power means for the people of Afghanistan have centred around the rights of women, access to education for the whole population, and the continuing prosperity of the country… However what this means for health is still uncertain.

Nadia Akseer is an Afghan scientist and epidemiologist, now working at John's Hopkins Bloomberg School of Public Health and who has published extensively the health of her home country

Reading list; Achieving maternal and child health gains in Afghanistan https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30002-X/fulltext

Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2754253

Coverage and inequalities in maternal and child health interventions in Afghanistan https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3406-1

Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30025-1/fulltext

In this month's Talk Evidence, Helen Macdonald and Joe Ross are back with a wry look at the world of Evidence Based Medicine.

They give us a round up of real world data emerging to address various uncertainties about vaccinations against covid

Helen has an update on NHS Digital’s project to extract GP coding for planning of healthcare and research, and talks to Natalie Banner from Understanding Patient Data, to find out what the public really cares about.

Finally, as routine care must go on a clinical review on cardiovascular disease in older adults introduces us to geroscience.

Reading list

Vaccines; Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study - https://doi.org/10.1136/bmj.n1943

Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study - https://doi.org/10.1136/bmj.n2015

Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study https://doi.org/10.1136/bmj.n1868

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study - https://doi.org/10.1136/bmj.n1931

CVD Cardiovascular care of older adults - https://doi.org/10.1136/bmj.n1593

The Midlands Charter, is a set of principles that hospitals in the midlands region of England have signed up to, to improve the health and wellbeing of trainees working in the area. It was created in a huge collaboration of trainees, NHS England, Health Education England and the GMC.

Dan Smith is a junior doctor at Nottingham University Hospitals NHS Trust, and one of the authors of that charter. He joins us to explain how they're QI thinking to improve doctors wellbeing, and how other areas can follow their lead.

Read the full charter: https://www.england.nhs.uk/midlands/information-for-professionals/nhs-midlands-charter/

To join the collaborative https://future.nhs.uk/MidlandsCharter/grouphome

Rota gaps are a big problem when it comes to loading stress on the medical workforce, and there is big pressure to spread the workforce as evenly as possible across wards and shifts.

However the tyranny of the rota - especially when changing rotations or working across multiple sites, means that often doctors personal wishes, or big life events are not taken into account.

The dehumanising status of becoming just a number in the system is not helping people have the kind of fulfilling careers that encourages people to stay within the workforce, and helps guard them from burnout.

So how do we square that circle? Anas Nader, CEO of Patchwork Health, joins us to talk about why his own burnout lead him to try and fix the rota problem - and where he has got to now.

Findout more at: https://www.patchwork.health/

Note - BMJ company has invested in patchwork health

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities

www.bmj.com/gender

In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.

As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.

In this podcast, we're joined by lawyer and activist Hina Jilani, who has been campaigning for women's rights in her native Pakistan for her whole life.

She and her sister set up the first female law firm in the country, she established a refuge for women who were fleeing violence and abuse, she was one of the founders of the Human Rights Commission of Pakistan, and is now an advocate on the country's Supreme Court. She is also one of The Elders.

Hina talks about her career, how she has pulled the various levers of change - lobbying for legislation, legal challenge, and protest - to improve the lives of women in Pakistan.

The additional interviews are from; Lia Quatrapella, Asha George, and Veloshnee Govender

In the wellbeing podcast, we have had a lot of personal experience of the pandemic, and schemes to support staff - but always we've wanted to know if there's research which can tell us how universal those experiences have been.

In this podcast, Abi and Cat are joined by Danielle Lamb, senior research fellow at University College London, and Sam Gnanapragasam, clinical fellow in psychiatry at South London and the Maudsley NHS Trust. Danielle and Sam are both investigators on NHS Check - a representative survey of NHS staff about their mental wellbeing during covid-19.

https://nhscheck.org/

The 19th of July in the UK saw the relaxation of covid rules that have been in place for 18 months - social distancing requirements in venues, mask wearing in public will no longer be legally mandated.

There are a lot of questions about what this will mean for the pandemic, and in this episode of Talk Evidence Helen MacDonald, Joe Ross and Duncan Jarvies are joined by Iain Buchan, professor of public health in Liverpool, who has been involved in 2 key studies on covid transmission.

Firstly, lateral flow tests - the big questions has been how well do they work in the wild - and how well do they have to work, to be useful in test trace and isolate? Iain tells us about new research into the innova test.

Secondly, events - the football has shown that events can still be a big source of transmission, and the UK government put in place a number of trial events, all carefully monitored by public health researchers - Iain tells us about one nightclub test in Liverpool, and what we can glean from it.

Reading list;

Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study https://www.bmj.com/content/374/bmj.n1637

The UK government's events programme https://www.gov.uk/government/publications/events-research-programme-phase-i-findings/events-research-programme-phase-i-findings#findings https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/979461/S1195_Science_framework_for_opening_up_group_events.pdf

Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data https://www.bmj.com/content/373/bmj.n1343

Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial https://www.bmj.com/content/374/bmj.n1585

Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis https://www.bmj.com/content/374/bmj.n1446

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities

www.bmj.com/gender

In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.

As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.

In this first podcast, Lulit Yonas Mengesha talks to Cara Tannenbaum

Lulit Yonas Mengesha is right at the beginning of her medical career, she's a medical student in Ethiopia, but has already become passionate about woman's health

Cara Tannenbaum is is Scientific Director of the Institute of Gender and Health at the Canadian Institutes of Health Research.

Lulit and Cara discuss how women have been excluded from healthcare research - and how that affects practice today, how there are gaps in our understanding of basic biology, as well as how different life experiences affect outcomes.

The additional interviews are from; Lavanya Vijayasingham, Claudia Lopes, and Claire Wenham

We know the pandemic has disproportionately affected the NHS workers who come from a ethnic minorities, we also know that doctors from an ethnic minority face additional barriers to accessing support - so how well have the various support schemes put in place during the pandemic helped those doctors from ethnic minorities?

Dammie Olubawale, medical student and grants and partnerships manager at Melanin Medics, joins us to talk about a fund they've created specifically to help doctors of black African and Caribbean heritage, to access support tailored to them.

Dammie explains some of the reasons which doctors, particularly from that heritage, may be more reluctant to access support - and how organisations large and small need to think about tailoring their wellbeing initiatives to include all staff.

To access the melanin medics wellbeing fund visit https://www.melaninmedics.com/wellbeing-fund

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities

https://www.bmj.com/gender

In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.

As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.

In this first podcast, Adrienne Germaine talks to Fila Magnus.

Adrienne starter her career as an activist for women's health in the 1970s, and went on to become president of the International Women's Health Coalition

Fila Magnus is Director of Communications at the International Youth Alliance for Family Planning, and was born in the same year as the Declaration was signed.

Fila and Adrienne discuss campaigning, now and then, and how the work that led to the declaration can be built on, but is never over...

The additional interviews are from; Emma Fulu, Sheena Hadi, Oswaldo Montoya, and Claudia Garcia-Moreno.

In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM.

Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible.

Read the full research here - https://www.bmj.com/content/373/bmj.n1137

The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done.

Read the full research - https://www.bmj.com/content/372/bmj.n579

GP data in the UK - the planned cut-off for granting access to your GP data for researchers has been extended, but there are still a lot of questions remaining. Helen has tried to find out some basic answers, and is still confused.

Finally, the FDA has approved a new drug for treatment of dementia - and researchers (and the FDA's own panel of experts) are up in arms. Joe Ross tells us why he thinks the decision was the wrong one, and why patients may be harmed because of it.

https://edition.cnn.com/2021/06/17/opinions/biogen-alzheimers-drug-opinion-ramachandra-ross/index.html

We've been bringing you stories of doctors wellbeing for a while in the podcast, but we noticed a pattern. Woman would come on and talk about their own difficulties, men would talk about other peoples - so we wanted to dive into that a bit, and called out on twitter for men who would be willing to open up to our listeners about their own mental health.

This interview is with Zeshan Quereshi - registrar in paediatrics, author and TedX talker. In this conversation we talk about why it is that men are particularly disinclined to open up about their difficulties at work, and what Zeshan has done to try and support his own.

Zeshan's TedX talk https://www.youtube.com/watch?v=uctoTk64GVM

Finally it seems that life might return to normal in the UK, as the vaccination efforts continue apace, and despite concern about increasingly spreading variants, our hospitals are not being overwhelmed.

Because of this, we are changing our approach to covering the pandemic - and taking this second wave podcast to pastures new, but before that, in this last episode we’re going to look backwards and forwards, at the UK’s response.

On the panel today are

Matt Morgan, consultant in critical care, Nisreen Alwan, associate professor in public health, Partha Kar, consultant in diabetes, and Helen Salisbury, GP.

www.bmj.com/coronavirus

The pandemic has wrought a lot of change, not least to doctors relationship to their careers. While still loving the patient interaction, we're increasingly hearing that doctors are disillusioned with the other aspects of medicine.

If you're feeling that way, there are ways to structure your thinking to help you make sense of your career. In this podcast Claire Kaye, former portfolio GP and now coach, explains how she went about deciding medicine wasn't for her, and how she helps doctors go through that process too.

You can find Claire at https://www.drclairekaye.com/ https://www.instagram.com/drclairekaye_executivecoaching/

In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19.

They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine.

This week, the team bring you updates on;

Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring.

Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine.

How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach.

and finally, research that showed non-drug interventions are as good as pharmaceuticals at treating people with depression and dementia - and the holistic effect that alleviating depression can have.

Full reading list Ayoubkhani, Daniel, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, and Amitava Banerjee. 2021. “Post-Covid Syndrome in Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study.” BMJ 372 (March): n693. https://www.bmj.com/content/372/bmj.n693

Pottegård, Anton, Lars Christian Lund, Øystein Karlstad, Jesper Dahl, Morten Andersen, Jesper Hallas, Øjvind Lidegaard, et al. 2021. “Arterial Events, Venous Thromboembolism, Thrombocytopenia, and Bleeding after Vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: Population Based Cohort Study.” BMJ 373 (May): n1114. https://www.bmj.com/content/373/bmj.n1114

Smith, Louise E., Henry W. W. Potts, Richard Amlôt, Nicola T. Fear, Susan Michie, and G. James Rubin. 2021. “Adherence to the Test, Trace, and Isolate System in the UK: Results from 37 Nationally Representative Surveys.” BMJ 372 (March): n608. https://www.bmj.com/content/372/bmj.n608

Watt, Jennifer A., Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A. Khan, Marco Ghassemi, Yonda Lai, et al. 2021. “Comparative Efficacy of Interventions for Reducing Symptoms of Depression in People with Dementia: Systematic Review and Network Meta-Analysis.” BMJ 372 (March): n532. https://www.bmj.com/content/372/bmj.n532

This interview is part of our BMJ interview series, where we talk to the people who are changing medicine. The series thus far has been a bit male dominated - reflecting the leadership in medicine at the moment, if not the actual workforce.

One woman who's planning to change that is Roopa Dhatt, executive director of Woman in Global Health - a new grassroots organistion which is making waves with its demand for equality of representation for woman in global health decision making.

In this interview, we talk to Dr Dhatt about the genesis of Woman in Global Health, and how they've managed to cement real commitment from the WHO. We also discuss how her experience of being Indian and American has shaped her understanding of equality in medicine, and how the covid-19 pandemic has highlighted the way in which women are discounted.

In medicine, a lot of work has been done to encourage person centred care - but can that maxim be extended to the people working within the healthcare system?

Subodh Dave has just been elected as dean of the Royal College of Psychiatrists, and joins us fresh from talking at the International conference on physician health to speak about his ambition to humanise medicine.

In this podcast, Subodh, Abi and Cat discuss what lessons from the pandemic need to remain, why at this time it's really important to look out for your colleague with family overseas, and how ice cream trucks meant much more than a cold treat.

www.bmj.com/wellbeing

On this wellbeing podcast, Abi and Cat are joined by Emma Lishman, a clinical psychologist and part of the North Bristol NHS Trust's staff wellbeing team.Emma helps doctors return to training after a break - be that for maternity leave, or covid-19.

Emma describes some of the fears that doctors who have been shielding have expressed coming back onto the ward, the ways in which teams may inadvertently make those worse, and the problems with complying with risk assessments in the face of staffing pressures.

Wellbeing podcasts have focused a lot on the importance of openness about mental health in the NHS, but in this podcast, you'll also hear how reluctant clinicians are to discuss physical health problems - and why the taboo around all aspects of illhealth needs to be tackled.

For more wellbeing https://www.bmj.com/wellbeing

Recorded on Tuesday 13th of April, as the shops open in the UK, and England is heading to the beer gardens. The roll out of the vaccination programme has completed its first phase, and second doses have been given to the most vulnerable people - and now the under 50s are starting to get their first doses.

In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.

The genomicc trial Matt mentions is still recruiting - if you're interested more detail is available here https://genomicc.org/

The synergistic linking of increasing health and wealth is broadly accepted - it's an integral part of the thinking between the Sustainable Development Goals, and the World Bank's call for universal healthcare as a way of boosting a country's economy.

But the quantification of that link - the extent to which a particular health intervention, has broader economic impacts, is actually pretty poorly understood.

In this podcast, we hear from some economists, who have an idea about how we could - fairly easily - measure those impacts at the same time we measure clinical efficacy.

Joining us are, Dean Jamison, professor emeritus of global health at the University of Washington Osondu Ogbuoji, assistant research professor at Duke Global Health Insitute. Till Bärnighausen, director of the Heidelberg Institute of Global Health Sebastian Vollmer, professor of development economics at the University of Göttingen

The collection that prompted this discussion is "Health, Wealth and Profits" - https://www.bmj.com/health-wealth-profits

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined again by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale.

This week we update you on treatment - the WHO's guidelines for covid and ivermectin, and why they're not ready to recommend it's use in treatment, and prophylactic anticoagulation treatment.

We hear about two papers from the UK and Switzerland which look at children and covid, and we pick up on varients of concern and long covid.

Reading list. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England https://www.bmj.com/content/372/bmj.n628

Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools https://www.bmj.com/content/372/bmj.n616

Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study https://www.bmj.com/content/372/bmj.n579

Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study https://www.bmj.com/content/372/bmj.n311

Editorial - Prophylactic anticoagulation for patients in hospital with covid-19 https://www.bmj.com/content/372/bmj.n487

Living with Covid19 – Second review - Informative and accessible health and care research https://evidence.nihr.ac.uk/themedreview/living-with-covid19-second-review/

In the UK, phase 2 of our coronavirus vaccination strategy may be delayed by supply problems, at the same time many GPs, who carried out the majority of the first vaccination phases, are declining to take on the addition burden and are trying to return to normal clinical work.

In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.

In this Wellbeing podcast, sponsored by medical protection, Abi Rimmer and Cat Chatfield talk to Susanna Petche and Reina Popat, GPs and members of First You - an organisation of healthcare workers, promoting wellbeing in the NHS. They discuss why it is that clinicians learn to subjugate their own wellbeing to their patients', and the ways in which working in the healthcare system perpetuate that. They discuss how systemic change can come through individual action, and how peers can band together to support each other.

This round table, recorded at the nuffield summit 2021, asks what does following the science actually mean - do ministers understand the nuance of the science in the pandemic, and how does uncertainty get interpreted through the lens of ideology and the power of compelling stories.

Taking part are: Kamran Abassi, executive editor of The BMJ Partha Kar, consultant in diabetes and endocrinology Deborah Cohen, health correspondent for BBC Newsnight Tom Sasse, associate director at the Institute for Government Christina Pagel, professor of Operational Research at University College London Matt Morgan, intensive care consultant Andy McKeon, chair of the Nuffield Trust Isobel Hardman, assistant editor of The Spectator Mary Dixon-Woods, director of This Institute Ben Page, chief executive of Ipsos MORI Alexandra Freeman, executive director of the Winton Centre for Risk & Evidence Communication Will Moy, chief executive of Full Fact Nigel Edwards, chief executive of the Nuffield Trust

In a slightly different talk evidence, Helen Macdonald and Duncan Jarvies are bringing you a couple, of in depth interviews,

Firstly, Anthony Harnden, GP, academic and member of the UK's Joint Committee on Vaccination and Immunisation takes us inside their decision making, and explains what evidence they look at, how they assess it, and what the next year of vaccination may look like.

Also in this episode, Gordon Guyatt, one of the founders of EBM, joins us to talk about Grade - the framework in which evidence for guidelines can be assessed - and explains why the most important thing is not the RCTs, but being very clear about what the guideline is supposed to achieve.

https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

https://www.gradeworkinggroup.org/

Never has the spotlight been as strong on a clinical trial as that on the Pfizer BioNTech vaccine, the first approved for covid-19.

In this interview, Joanne Silberner spoke to its lead principal investigator, Stephen Thomas chief of infectious diseases at SUNY Upstate Medical University, New York, became the lead principal investigator for one of the most closely watched clinical trials in history.

They discuss the moment the positive results came through, what will happen to the people who are still enrolled in the trial, but got a placebo dose, and why the trial was designed in the way it was.

www.bmj.com/coronavirus

Many surgeries have been cancelled during the pandemic, with good reason, as early data showed the increase in mortality associated with a coronavirus infection, but now waiting lists grow, and there are questions about how the NHS will pick up the slack.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.

They are joined by Mary Venn, research fellow, and honorary surgical registrar in London, who's been looking into the pandemic's effect on surgery. For more on that research:

http://nihrglobalsurgery.org/surgeryduringcovid

To register for our covid known unknowns webinar - https://www.bmj.com/covid-19-webinars

Ashling Lillis is a now consultant in acute medicine at Whittington Health NHS Trust, but she was almost a consultant in intensive care medicine - but a mental health crisis just 6 months before she qualified made her reassess her career, and choose a different path.

In this podcast, Ash talks to Abi and Cat about the difficulty many doctors have when discussing their mental health - and how speaking out about her own experiences, has encouraged others to talk to her privately - and opened her eyes to the extent of the problem in the NHS.

www.bmj.com/wellbeing

Jeremy Farrar, is director of the Wellcome Trust, as well as advisor to the government on SAGE. Trained as a medic and with a PhD in neuro-immunology, he was a professor of Tropical Medicine and Global health at the University of Oxford.

In this podcast, he tells us why he thinks that vaccine nationalism is a very short-termist response the pandemic, and why he's bullish about new variants of the SARS-CoV-2 virus.

www.bmj.com/coronavirus

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. This week our special guest is Rachel Clarke, author and palliative care specialist.

The panel discuss how end of life care has changed in the pandemic, and how clinicians have become targets of abuse on social media, for speaking out about things like masks and hospital capacity.

The observation period, after receiving a covid-19 vaccination may be the only 15 minutes someone in the NHS might get all day.

In this podcast, we're joined again by Chris Bu, psychiatry trainee who has previously spoken to us about how Burmese Buddhism helped him in his training.

He takes us through a guided mindfullness meditation, tailored to that post-vaccination period, to help you make the most of your observation time.

www.bmj.com/wellbeing

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale.

This week we pick up on a preprint in medRxiv, which has been attracting attention on social media - it tries to look at the longer term effects of covid hospitalisation.

Joe explains why he thinks propensity matching can be summarised as "doing your best".

Finally, as more and more care moves remotely, we discuss a trial on a digital intervention to help manage poorly controlled hypertension remotely.

Reading list: Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1.full.pdf

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial https://www.bmj.com/content/372/bmj.m4858

Neil Greenberg is a psychiatrist, and professor of Defence Mental Health at King's College London. He spent 23 in the military, and now continues to work with them on things like peer led traumatic stress support packages.

A recent survey of NHS staff showed disturbing signs that covid-19 has caused a widespread trauma in staff, so in this podcast we talked to Neil about trauma and moral injury, what some of the warning signs are, and what individuals and organisations can do to help their colleagues.

www.bmj.com/wellbeing

Jeremy Hunt probably needs no introduction to our audience - the UK's longest serving health minister, he now chairs Westminster's Health and Social Care Committee - the powerful committee that holds the government to account for its policy choices.

In this interview Gareth Iacobucci asks Hunt if he regrets his decision to impose the contract on junior doctors which lead to their industrial action, how workforce issues have left the NHS in a poor state to deal with a health emergency. They also talk about the potential for a public enquiry into the government's handling of the pandemic, and what an upcoming committee report into the same issue might find.

The "public health emergency of international concern" was issued by the WHO a year and a lifetime ago. As the UK ramps up testing for the South African virus variant, and is full steam ahead on vaccination, we look back at what we've learned in that time.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.

They talk about working in the NHS at the moment, the utility of international comparisons, and their remaining questions about vaccination regimes.

www.bmj.com/coronavirus

It’s been just over a year since the WHO declared the pandemic a “Public Health Emergency of International Concern” - if you cast your mind back to then, the news was full of reassurances about how prepared the UK and the USA were for a pandemic.

Now a year later, with the benefit of hindsight, that confidence was wildly overstated - but why was that, what is the gap between that theoretical readiness, and reality.

In this podcast we're joined by talking to Tom Frieden - former director of the Centres for Disease Control and Prevention, under President Obama, and who has a long history of public health leadership.

He talks about the gap between the apparatus to do something, the the political will to do that. Why data have been lacking, and the interaction between a infectious and non-infectious diseases.

www.bmj.com/coronavirus

Recorded on the 26th January 2021

The UK has become, officially, the worst performing country in terms of Covid-19 deaths, per head of population - and the number of people in hospital is still higher than at any point in the pandemic.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.

They talk about working in the NHS at the moment, and the challenges in things like oxygen and vaccine supplies. How the pandemic has exposed a gap in general medicine, and the importance of challenging poor responses at all levels.

In the UK, over 37,000 people are in hospital with covid-19, and the NHS comes closer than ever to being overwhelmed - though 4 million people have received their first dose of the vaccine, we are warned that things will get worse before they get better.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on hospitals, why GPs are questioning the need for max vaccination centres, and why the public health approach can't be just lockdown and vaccinations.

www.bmj.com/coronavirus

US president elect Joe Biden wasted no time in appointing a special advisory board of experts to guide America out of its coronavirus crisis.

One of those experts is Celine Gounder, an infectious diseases epidemiologist who has worked on Ebola, tuberculosis, and HIV in Africa and South America. She’s a clinical assistant professor of medicine and infectious diseases at New York University’s School of Medicine, as well as an active writer and podcast host, including of Epidemic

In this podcast she talks to Joanne Silberner about the ways in which the taskforce is helping prepare for action immediately after the inauguration, what the big challenges they need to tackle are, and how they plan to rebuild trust in the U.S. covid response.

https://www.bmj.com/content/372/bmj.n33

In this episode of Talk Evidence, Jon Deeks, professor of biostatistics at the University of Birmingham, returns to the pod with an update on lateral flow tests - and why the government plan for using them in asymptomatic screening for covid-19 doesn't follow the science.

We're also joined by Allyson Pollock, clinical professor of public health at Newcastle University, and author of a recent editorial in The BMJ about asymptomatic transmission of SARS-CoV-2. She explains why she thinks supporting social isolation is the missing piece of our approach to tackling the pandemic.

Covid-19 INNOVA testing in schools: don’t just test, evaluate https://blogs.bmj.com/bmj/2021/01/12/covid-19-innova-testing-in-schools-dont-just-test-evaluate/

Asymptomatic transmission of covid-19 https://www.bmj.com/content/371/bmj.m4851

Andrew Pollard is Director of the Oxford Vaccines Group - who, along with Astra Zeneca, have developed an modified adenovirus vaccine for SARS-CoV-2.

In this interview we talk to him about the development of that vaccine - what he thinks about the UK government's plan to increase the interval between doses; if he worries about a mutating virus and vaccine escape; and how the university came to make a deal with a commercial company to provide cost-price vaccinations for the world.

www.bmj.com/coronavirus

The Samaritans have traditionally been there for people in a crisis, those who are on the verge of ending their life by suicide - but during this pandemic, with the personal toll of caring for covid-19 patients, they are also here to provide emotional support for NHS staff however they are feeling.

In this podcast, Ben Phillips, head of service programmes for Samaritans joins us to explain how being listened to can help - and how to tactfully point your colleagues towards that emotional help if you feel they need it.

If you need support at this time you can call 0800 069 6222 or visit https://www.samaritans.org/how-we-can-help/health-and-care/

The growth in the need for food aid, in the UK, has been staggering. That's why The BMJ has chosen the Independent Food Aid Network (IFAN) as its annual charity appeal.

Nutritional guidelines which work for everyone is difficult, even harder for food aid providers who have to factor in things like long term storage, reduced access to fresh produce and in some cases the inability to afford the electricity to cook with.

In this podcast, Sabine Goodwin, IFAN's coordinator is joined by Isabel Rice, dietician at the charity Centrepoint, and Dee Woods, co-chair of IFAN and who co-runs Granville Community Kitchen, a food aid provider in London.

Please time the time to donate at; https://www.foodaidnetwork.org.uk/bmj

Recorded Tuesday 5th Jan 2021

As the UK enters lockdown, again, schools are closed, the NHS struggles under the surge of cases, new variants of SARS-COV-2 virus stalk the world, and vaccination programmes make a faltering start.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on critical care, England's vaccination roll out, the closure of schools and why communication is undermining trust in the vaccines.

All the BMJ's corona virus coverage is currently free to access www.bmj.com/coronavirus

The BMJ has long campaigned for better patient and public participation in research, making the case that it leads to better outcomes for patients and for society - but an article published in the Christmas edition of The BMJ goes further than that - and talks about the insights that participants in research provide- insights that the academic team would never be able to have themselves.

In this podcast, Seb Crutch a professor of neuropsychology, and Martin Rossor, national director for dementia research - who have been involved in neurological research as academics, and also by Valerie Mansfield, who’s a member of a patient support group, discuss how the scientific establishment can recognise those invaluable insights.

Read the full article: https://www.bmj.com/content/371/bmj.m4478

As 2021 hoves into view, we look back at a year of extraordinary evidence.

Helen Macdonald is joined by Joe Ross, one of The BMJ's research editors, as well as a researcher at Yale.

They discuss the way in which clinical pre-prints have become an important part of the research ecosystem, especially during the pandemic, and pick up on some of the non-coronavirus things you might have missed in the deluge of data.

In this end-of-year podcast from Deep Breath In, we're bringing you a light hearted look back at 2020, and trying to remember some of the non-covid-19 medicine that has crossed our desks.

This festive quiz features the deep breath in gang, as well as Cat Chatfield from the Wellbeing podcast, and Helen Macdonald from our Talk Evidence podcasts.

Reading list; Thyroid disease assessment and management: summary of NICE guidance https://www.bmj.com/content/368/bmj.m41

Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline https://www.bmj.com/content/365/bmj.l2006

Judd Brewer's advice for coping with burnout https://drjud.com/

If you've had time to digest this year's Christmas edition of The BMJ, you might have wondered how those papers get into The BMJ.

Well in this Talk Evidence podcast, Helen Macdonald, UK research editor at The BMJ talks to two of her research team colleagues, John Fletcher and Tim Feeney, as they talk through why they chose their favourite papers.

Toxicological analysis of George’s marvellous medicine https://www.bmj.com/content/371/bmj.m4467

Does medicine run in the family—evidence from three generations of physicians in Sweden https://www.bmj.com/content/371/bmj.m4453

The time to act is now https://www.bmj.com/content/371/bmj.m4143

How do human behaviours affect patient outcomes? And what has that got to do with Christmas?

Graham Shaw, director of Critical Factors, and Peter Brennan, a maxillofacial surgeon in Portsmouth, join us to explain what human factors are, why they’re not a bigger part of medical training, and talk about their importance as the NHS comes under greater and greater pressure because of the surge in covid-19 cases.

They also offer a word of advice to Santa, about making sure a festive never-event never happens.

www.bmj.com/wellbeing

Every year, the BMJ has a charity appeal - we’ve regularly focused on organisations like MSF, or Lifebox - providing support to areas of the world which don’t have good healthcare provision… This year though, covid-19 has changed everything - and we’re focussed inwards, on the UK.

With growing unemployment, sections of the population being laid off, and with the well documented delays in receiving universal credit - food insecurity has become a major issue in the sixth largest economy in the world.

In this podcast Martin Caraher, emeritus professor of food and health policy at City University of London, explains how this crisis is a long time coming, and the result of the inattention of successive governments to the issue of hunger.

We also hear from Sabine Goodwin, coordinator of the Independent Food Aid Network, the recipients of this years award funds, about how the their network is being affected by the covid-19 pandemic, and how your money will be used to supports food banks, and advocate for their obsolescence

Donate the the Independent Food Aid Network here: https://www.foodaidnetwork.org.uk/bmj

Until hear death in 2019, Annabel and her husband James Weaver, spent a lot of time together in hospitals - in patient and outpatient wards, waiting in makeshift waiting rooms in corridors and atriums. And while you or I might notice things about the way in which the hospital looks - James and Annabel noticed the way in which is sounded.

James is perusing a PhD at Queen Mary University of London into acoustics and the intelligibility of sound - and in this podcast we delve into the sound of a hospital, and why it can make communication between staff and patients so hard.

Read James's Christmas article, The sound of medicine https://www.bmj.com/content/371/bmj.m4682

Robert Poynton is an associate fellow of the Saïd Business School at the University of Oxford, and author of books designed to help people work in ways which help both their career and wellbeing.

In this wellbeing podcast, we focus on "Do Pause; you are not a to do list" - a book that Cat has had on her to do list for months.

Rob explain to us what the concept of "pausing" is, and why he thinks a small gesture can have a significant effect on our ability to deal with the stresses of day to day work life.

Rob's books are available on Bookshop

Do Pause https://uk.bookshop.org/a/98/9781907974632

Do Improvise https://uk.bookshop.org/a/98/9781907974014

As London and some neighbouring counties move up to tier 3, and Germany, Italy and The Netherlands impose tighter restrictions over over the coming days of Christmas, in this podcast we ask - should Christmas gatherings be cancelled?

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.

They're joined by Mike Tildesley, reader in mathematics at Warwick School of Life Sciences, who models infectious disease spread.

They discuss why the key to controlling is pruning network connections - but why that concept hasn't been well explained to the public, what's happening in Cardiff, where ICU is running at 120% capacity, and how the vaccine roll out is being coordinated in primary care.

For more on the pandemic www.bmj.com/coronavirus

The last few weeks we’ve been feverish in our coverage of vaccines - the evidence base for them is, how they’ve been evaluated and licensed, and who’s going to get them first.

But what we’ve not covered much is what it’s like to do, and take part in, a vaccine trial.

In this special podcast, we’re going to hear from John Wright, director of the Bradford Institute of Health Research. He’s been keeping a “doctors diary” for BBC radio, and in this podcast we’re doing a deeper dive into that - and finding out about the people working on, and volunteering to test, a corona virus vaccine.

The vaccines are being rolled out - but approval is still on an emergency basis, and the evidence underpinning those decisions is only just becoming available for scrutiny.

In this podcast we talk to Baruch Fischhoff, professor at Carnegie Mellon University and expert on public health communication about how that messaging should be done.

Peter Doshi, associate editor at The BMJ, and vaccine regulation researcher also joins us to talk about the data now released on the vaccine trials - what questions does it raise, and what are the next steps for researching safety.

For more on The BMJ's covid-19 coverage www.bmj.com/coronavirus

As the first people outside of a trial have started receiving Pfizer's sars-cov-2 vaccine, including Matt, but that's not the end of the story for the pandemic, there are still logistics of rollout, plus treating those who have already contracted the disease.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.

They discuss why it's impossible to get the vaccine into care homes, because of the need for very low temperature storage, why the survival rate in ICU has gone down, and how messaging on the non-vaccine ways of preventing spread need to be tightened up, especially now.

For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

Anne Hicks, is an emergency medicine consultant in Plymouth, and for 16 years was the medical director for the British Antarctic Survey (she stepped down last year).

The British Antarctic Survey operates all through the antarctic winter - where for 90 days, the sun sets and plunges their base into cold and darkness. So who better to give us some advice on coping with the strict covid-19 rules during our winter period.

Anne talks to Cat Chatfield about the ways in which structure, even the seemingly small and arbitrary, can help, how to spot signs of someone struggling, and how the lack of daylight affects teams working at the bottom of the world.

https://www.bmj.com/wellbeing

As the first vaccine for corona virus is approved, and England joins the other nations of the UK outside of full lockdown, we are all entering tiers of restrictions - variable across the country, which will continue until that vaccine coverage is enough to slow transmission in the community.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and are re-joined by Karl Friston, neurologist and member of iSAGE.

They discuss what we know about the efficacy of these tiers, and how they interact with things like track and trace, and the mass testing taking place in Liverpool.

For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

The government has decided to pursue a strategy of mass-testing in Liverpool, in a pilot to see what effect that has on containment of corona virus.

A lot of criticism has been levelled at the scheme, from the sensitivity of the lateral flow test used, to whether this is screening and should be referred to the national screening committee to be evaluated.

Calum Semple, professor of child health and outbreak medicine at the University of Liverpool is evaluating the project, and joins us to explain what we can understand from this - how initial data shows the new testing regime is reaching more of the population, and why he thinks this is a public health intervention, not a personal screening test.

www.bmj.com/coronavirus

The BMJ is a champion of openness and transparency in research, in clinical practice and in health policy.

However, if you’ve kept and eye on the journals recently, you’ll have seen that governments have been less diligent about keeping an eye on competing interests than they should be.

In this podcast we’re joined by Jolyon Maugham QC - one of the founding members of the Good Law Project, who have successfully litigated against the government on Brexit, and are now turning their eyes to procurement during the pandemic.

Jo talks to Kamran Abbasi about how big the contracts have been, how the UK’s system lacks the checks and balances to prevent a government from forging ahead, and if cronyism and corruption have damaged the pandemic response

www.bmj.com/coronavirus

As further promising news emerges of vaccine effectiveness, although still with no data published, and as plans emerge for the return home of university students and limited festive winter celebrations.

But as we talked about in the last podcast, there needs to be a concerted effort to re-centre patients and the public within the decisions made about how the NHS will treat covid patients and those with continuing healthcare conditions impacted by the pandemic.

National Voices, a coalition of charities that stands for patient centred care, have been talking to patients about what matters to people during COVID-19 and beyond, and have written a report with some clear recommendations to health and care leaders and professionals.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.

They are joined by Charlotte Augst, Chief Executive of national voices to talk about that report; why some patients have felt abandoned; how covid has accelerated the conversation about rationing; and why now is the time to rebuild services around patient needs.

www.bmj.com/coronavirus

Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect.

As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen.

Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment.

John tells us about the Danmask study - what question it was actually trying to answer.

We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb.

Reading list: A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379

Covid-19’s known unknowns https://www.bmj.com/content/371/bmj.m3979

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers https://www.acpjournals.org/doi/10.7326/M20-6817

Clare Gerada and Zaid Al-Najjar have been treating doctors for a while now, through the NHS Practitioner Programme.

In that time they have noticed some themes in the issues that bring doctors to them, from isolation to stress.

In this podcast they reflect on what they've learned about the problems that affect doctors, and how covid-19 has exacerbated some, and surprisingly reduced others.

Their book Beneath the White Coat: Doctors, Their Minds and Mental Health is out now https://www.routledge.com/Beneath-the-White-Coat-Doctors-Their-Minds-and-Mental-Health/Gerada/p/book/9781138499737

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Katrina Pollock, senior clinical research fellow in vaccinology at Imperial College London, to talk about: the three vaccines in the news; why different groups may require different vaccines; and how to choose who to get the vaccination first.

www.bmj.com/coronavirus

In the first wave of covid-19, hospitals started to reconfigure space and services, to provide rest areas and food for staff, to help them cope with the surge in patients.

Michael West, professor professor of work and organisational psychology at Lancaster University Management School, returns to the podcast to talk about how well those changes helped staff - and what needs to be done, now that a second wave is hitting, to make sure those essential services don't disappear.

www.bmj.com/wellbeing

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts.

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Alison Pittard, a consultant in anaesthesia and intensive care medicine in Leeds, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.

They are joined by Müge Çevik, an infectious diseases researcher at the University of St Andrews, to talk about: what’s happening with track and trace and how to make it work better; transmission and asymptomatic spread, in particular hospital-acquired infections; views on the news of Pfizer’s vaccine; and reaction to US presidential election.

www.bmj.com/coronavirus

A lump in the throat is a classic GP presentation, but one that often causes a lot of worry. Many people are struggling with high levels of anxiety anyway at the moment, and this may manifest physical symptoms, such as fatigue, insomnia and dysphagia.

In this week’s episode, we discuss how to differentiate between causes of a lump in the throat: is my patient experiencing laryngopharyngeal reflux, or could it be cancer? How do we reassure distressed patients when we need to refer them on for imaging, or a consultation with a specialist, before we can rule out a malignant cause?

We also talk about how to manage a patient who has difficulty swallowing pills, and the challenges of getting children, in particular, to take medication.

Our guests: Nick Hamilton is a clinical lecturer in otorhinolaryngology at UCL, and also works as a specialist registrar in otorhinolaryngology head and neck surgery at North Thames Deanery, London.

Deonne Dersch-Mills is the clinical practice leader for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary.

Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts.

In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.

They are joined by Andrew Hayward, professor of infectious disease epidemiology and inclusion health research, to talk about the lockdown in England, why the message should be clearer, what needs to be done to make the lockdown work, and how doctors are braced for the upcoming surge in cases.

https://www.bmj.com/coronavirus

In this talk evidence covid-19 update, we’re taking on risk - how do you figure out your individual risk of dying from the disease? Try QCovid, but remember that it’s figuring out your risk back in April.

When it comes to talking about risk, very few people actually engage with the number, so Alex Freeman from the Winton Centre for Risk and Evidence Communication at the University of Cambridge joins us to describe their research into more effective ways of presenting it.

Huseyin Naci, from the London School of Economics, returns to the podcast to talk to us about the problems of pulling all the trial data together, and where covid-19 has made people work together most effectively in tackling that issue.

Reading list;

Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults https://www.bmj.com/content/371/bmj.m3731

Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1

Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19 https://www.bmj.com/content/371/bmj.m3869.full

Chris Whitty probably needs no introduction to our UK audience - he's the chief medical advisor to the UK government, has played a pivotal role in shaping the country's response to Covid-19.

He rarely does interviews - so in this conversation we wanted to ask him the questions that matter to clinicians, about how the pandemic will impact them over the winter.

This was recorded yesterday, just before the announcement of the strict lockdowns in France and Germany.

For more covid-19 coverage www.bmj.com/coronavirus

As the world sees an upsurge in infections, this "second wave" feels different to the first - we have a much better understanding of the biology of the virus, in hospitals, guidelines for treatment have been rapidly developed... and the pipeline of research to improve that has been created.

But a lot of questions remain - particularly about the dynamics of the spread of respiratory viruses.

Which brings us onto this episode - in these weekly discussions, clinicians from across the healthservice and I will be joined by experts, so we can find out more about the issues that really matter to frontline staff.

Joining us today are BMJ columnists, Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire. We also have The BMJ authors, Nisreen Alwan, consultant in public health, in Southampton and Karl Friston, neurologist and member of iSAGE

For more of The BMJ’s covid-19 coverage.

www.bmj.com/coronavirus

Personality disorder is often referred to as the “Cinderella” diagnosis of mental health. Around 1 in 20 people is estimated to have a personality disorder, and it is a neglected and under-resourced area of our healthcare system. In this week’s episode, we discuss the stigma surrounding personality disorder, which can often manifest itself in high levels of anxiety for both patients and GPs, when it comes to diagnosing and managing it, and how to help a patient come to terms with their diagnosis.

With suicidal ideation being experienced by many people with a personality disorder on a regular basis, we also talk about how we may best manage a situation of a patient in crisis presenting in primary care.

Our guests:

Leisha Davies is a clinical psychologist, originally from South Africa, who currently works in private practice.

Soumitra Burman-Roy is a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust. He also works for Maudsley Learning, an organisation which provides mental health training for primary care.

Marie Stella McClure, who was diagnosed with borderline personality disorder at the age of 38, is the author of ‘Borderline: a Memoir’, a book about her life and experiences of BPD.

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts.

In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire - they discuss how full hospitals are getting, how many covid-19 cases are presenting in primary care, and how treating patients has fared as the pandemic hots up.

For more on covid-19 visit https://www.bmj.com/coronavirus

The "second wave" of covid is hitting the UK, and clinicians are anticipating a spike in demand in the NHS. The inevitability of that is weighing on NHS staff's minds.

In this podcast, Cormac Doyle, a retired senior army officer, who specialises in military mental health/ veterans and support other with psychological trauma, returns to the podcast to talk about his experience of deployment in the military, and how individuals and their employers can make the inevitability of a second wave less daunting.

For more wellbeing from The BMJ - https://www.bmj.com/wellbeing

As the economic fall out of covid-19 starts to bite, attention is turning to how the state can support everyone - especially if the pandemic turns into a depression.

Universal basic income, and a jobs guarantee are two of the potential mechanisms a country could deploy, both with different effects on people's health and wellbeing.

In this podcast, Martin Hensher, associate professor of health system financing and organisation at Deakin university in Australia, and author of the new analysis "Covid-19, unemployment, and health: time for deeper solutions?" joins us to get you up to speed on the economic thought behind these two schemes.

Read the full analysis; https://www.bmj.com/content/371/bmj.m3687

Persistent coughing in children is always a challenge, both for parents trying to describe and measure the cough, and for doctors making a diagnosis. In the current climate, this is all the more difficult, seeing as a continual cough is one of the major symptoms of COVID-19. UK Government guidance advises that anyone with a persistent cough should get a coronavirus test. But with the reopening of schools and the beginning of the cold & flu season both coinciding with a national shortage of tests available, should we all err on the side of caution and try to get a test at the first sign of a cough or sniffle, or can the data on cold virus symptoms help parents and GPs make an informed judgement on the likelihood that their child’s cough indicates COVID?

Our guests: Tim Spector is a professor of Genetic Epidemiology, and director of the TwinsUK Registry, at King’s College London.

Edward Snelson is a paediatrician in the paediatric emergency department at Sheffield Children’s Hospital.

In this Talk Evidence covid-19 update, Jon Deeks, professor of biostatistics at the University of Birmingham gives us an update on testing technology. Will the point of care tests make a different to big live events, and how research and regulation need to change to tame the testing wild west.

Paul Glasziou, professor of evidence based practice at at Bond University has set up a new collaboration to try and get better at creating evidence for non-drug/vaccine control of pandemics - and ponders why we're good at drug research, but terrible at other kinds.

David Pencheon, Renee Salas and Ed Maibach join us to talk about how healthcare can, and should, take leadership on climate change.

With a few exceptions, the healthcare industry lags behind in efforts to reduce carbon emissions - in this podcast, we'll discuss why that is, why now is the time to take decarbonisation seriously, and why Covid-19 is a hindrance, but also a potential pivot point for change.

A pathway to net zero emissions for healthcare https://www.bmj.com/content/371/bmj.m3785

For more on health and climate change https://www.bmj.com/campaign/climate-change

With the annual flu season looming, GPs are anticipating a frenzy of vaccinations, perhaps more so than ever this year.

As so many 'flu and respiratory viruses circulate every year, and as the 'flu vaccine is for one strain of influenza only, is the vaccine worth getting, and what are the risks associated with vaccinating vs. not vaccinating?

In this week’s episode, we discuss the high vaccine uptake in New Zealand, and the role that social distancing for COVID-19 may have played in their low numbers of seasonal flu.

We also talk about whether or not the message we give to patients about the benefits and risks of vaccination is transparent enough, and how we might communicate better with them to allow them to make an informed decision.

We feel pressure to increase vaccination rates, because we believe we are protecting people, but does the evidence support that?

Our guests:

Nikki Turner is the director of the Immunisation Advisory Centre (IMAC) at the university of Auckland. She is an academic general practitioner, and a professor at the university.

Jeff Kwong is a professor at the University of Toronto, and the interim director of the Centre for Vaccine Preventable Diseases at the university’s Dalla Lana School of Public Health.

This episode was recorded on 18 September - just before the news came out about the new lockdown measures. We’ll hear Carl and Helen’s thoughts, but we also want to hear a broad range of views - so get in touch at bmj.com/podcasts.

(1.15) The kids are back in school, and people are worried about the infection spreading. Helen takes us through the ISCARIC data on children's symptoms and outcomes from covid-19.

(5.50) David Ludwig, professor of pediatrics at Harvard Medical School and BMJ editor, joins us to give an overview of paediatric covid.

(15.30) Carl has thoughts about the spread of covid, and how it seems to be mirroring other respiratory illnesses.

(18.00) We wonder about the evidence for the "rule of six"

Nudging seemed to be all the rage a few years ago - a way of changing individual behaviours to help people make better choices, about their diet, exercise and other habits.

A lot of hype ensued, the UK government under Tony Blair even set up a “nudge unit” - but questions were asked about the efficacy of the approaches used, confusion about what a nudge actually was, and how to turn it into actual scalable change have followed the discipline.

In this podcast Craig Fox, behavioural scientist at UCLA, and author of a new analysis “Details matter: predicting when nudging clinicians will succeed or fail” joins us to explain why he thinks nudging could work in medicine.

https://www.bmj.com/content/370/bmj.m3256

To register for your free online place at BMJ Live 2020 visit https://live.bmj.com/

Dr Anthony Fauci needs no introduction, as head of the NIAID for almost four decades, and the U.S. government's leading advisor on infectious diseases, and leader in the country's response to Covid-19.

In this interview with The BMJ, Dr Fauci covers parallels in his experience in the HIV/AIDS crisis with this latest public health emergency. He talks about how his understanding of Covid-19 has changed.

We also tackle the reports of political intrusion into the CDC and, address worries about the rush toward a vaccine in time for the November elections.

For more from The BMJ's covid coverage, all available for free https://www.bmj.com/coronavirus

Fatphobia has been described as society’s last ‘ism’. Whilst our understanding of weight and health has changed over time, there is still a stigma towards people who are overweight or obese, and an assumption that they must be unhealthy, and unhealthy by choice. However, the correlation between weight and health may not be as clear cut as our societal biases would lead us to believe, and, therefore, the challenge for GPs is to make a conscious efforts to overcome our preconceptions so that they may provide the best support for our obese patients. This week, we discuss the need for a zero tolerance towards fat shaming at an organisational level, and how we can make GP practices more accessible for this group of patients. We also talk about retraining the palette in order to sustain weight loss, and our duty to lobby for better community-based weight management services.

Our guests:

Stephanie deGiorgio is a GP, and the clinical lead in the UTC at Queen Elizabeth The Queen Mother Hospital, Margate. She has a special interest in obesity.

Naveed Sattar is a professor of Metabolic Medicine at the University of Glasgow. His main research concerns investigating the prevention, causes and management of diabetes, heart disease and obesity.

The social norms that guide our behaviour in the world aren’t often quick to change - but the imperative to wear a mask in public has rapidly taken hold, establish by law, but policed by the public.

Mask shaming is a new phenomenon, but in this podcast, Brandy Schillace, author, historian and editor in chief of Medical Humanities (a BMJ journal) joins Cat and Abi to discuss how ineffective shaming is as a tool for behaviour change, and what mask-shaming reveals about the ways in which society treats those who are seen as non-conforming.

For more on The BMJ’s wellbeing campaign www.bmj.com/wellbeing

There are have been local lockdowns in the UK, in places such as Oldham, Birmingham, Manchester – but what is the criteria for making that decision?

In the non-Covid world: does honey alleviate symptoms in upper-respiratory tract infections? When does unexpected weight-loss warrant further investigation for cancer in primary care?

Plus, in the light of findings from the Cumberlege review of safety in medical devices, the team discuss the issue of doctors’ declaration of interests.

Contraceptive pill check-up appointments used to be simple and straightforward for GPs, and frequently felt like a welcome reprieve from more complex consultations. However, there’s often more to them these days, especially given the rise in tailored regimens, with more and more women moving away from the standard of 21 pills followed by a 7-day break.

In this week’s episode, we discuss common misconceptions around the pill cycle compared with a woman’s natural cycle, the various side effects caused by taking an oestrogen-dominant versus a progesterone-dominant pill, and the purely arbitrary nature of the standard regimen. How do we ensure that our patients are able to make an informed choice on their method of contraception, and how do we avoid the risk of contraceptive coercion?

Our guests:

Anne MacGregor is a professor, working in Secual ans Reproductive Healthcare at Barts Health NHS Trust. She is a specialist in women’s health, and also in headaches and migraines.

Tara Stein is a Family Medicine doctor at Montefiore Medical Center, and the Clinical Curriculum Manager for RHEDI – Reproductive Health Education in Family Medicine.

In Australia, a staggering 25% of doctors have had thoughts of suicide in the past 12 months, a recent survey said. Mental health problems are higher in medicine than any other job – and yet healthcare professionals are still stigmatised for seeking help. Partly in response to his own struggles, Geoff Toogood, a cardiologist in Melbourne, started an ingenious campaign called CrazySocks4Docs to highlight the issue.

https://www.crazysocks4docs.com.au/

Trisha Greenhalgh, professor of primary care health sciences at the University of Oxford has been a powerhouse of covid-19 evidence synthesis. She pulled together advice on doing remote consultations, on wearing masks to prevent spread, and a host of other information.

She’s now turning her attention to “long-covid” - as we learn more about the disease, it’s becoming apparent that it’s not just an acute infection, patients are reporting chronic long term consequences of having the virus.

In this podcast, she describes what we know about long-covid, where the uncertainty lies, and what clinicians should be doing to help patients who are experiencing the symptoms.

Management of post-acute covid-19 in primary care https://www.bmj.com/content/370/bmj.m3026

1.00) Carl has been looking at PCR testing, and explains why it picks up both viable SARS-cov-2, but also fragments of it’s RNA - leading to potential over diagnosis.

(8.50 ) What did the Living systematic review and accompanying guidelines say about treatment options for covid-19

(14.35) Helen talks to Reed Siemieniuk, general internist from McMaster University, about creating a living network meta-analysis, to try and synthesis all the evidence on covid-19

(22.48) Helen also talks to Bram Rochwerg, associate professor at McMaster University and consultant intensivist at Hamilton Health Sciences, about turning the outcomes of a meta-analysis into guidelines, and why at the moment they’re still calling for more evidence on Remdesivir

(30.08) Finally, there are worries about the uncertainty expressed in the living review - and in the way in which we communicate that. Helen goes back to Reed to find out how the review might evolve in the future.

(33.50) Covid isn’t just an acute disease, there is emerging consensus that it’s systemic effects lead to long term problems for some patients - but there’s a lot of uncertainty there.

(38.40) Carl talks about the IMMDS review and his involvement in it - and what recommendations we’ll be covering in future Talk Evidence programmes.

Reading list: Drug treatments for covid-19: living systematic review and network meta-analysis -https://www.bmj.com/content/370/bmj.m2980

Remdesivir for severe covid-19: a clinical practice guideline - https://www.bmj.com/content/370/bmj.m2924

Management of post-acute covid-19 in primary care - https://www.bmj.com/content/370/bmj.m3026

Interest in vitamin D, and it’s association with a range of health outcomes continues - at least if the regular flurry of papers on the subject that are submitted to The BMJ are anything to go by, and with Covid-19, interest has piqued again.

GPs are regularly asked to prescribe it, and to test for deficiencies. Low levels of vitamin D are associated with a large number of health outcomes, but, given the high costs and low accuracy of tests, would it be easier just to recommend taking supplements without testing vitamin levels first, taking a “won’t hurt but might help” approach? If so, should we all be taking them, and would doing so help to prevent against COVID-19?

Our guests:

Andrew Grey is an endocrinologist and an associate professor of Medicine at the University of Auckland.

Tom Chatfield is a philosopher, author and broadcaster, whose work looks at humans and technology, as well as cognitive biases.

Fresh outbreaks of covid in Europe and a wave of infections in the United States have been in the news this week, highlighting the renewed need for social distancing – but to what extent?

In this edition, we explore the real-world evidence for physical distancing measures as well as the research into whether or not facemasks make us behave more recklessly.

We also discuss the non-covid themes of research transparency and a BMJ investigation into the lucrative business of orphan drugs.

In light of the publication of the Independent Medicines and Medical Devices Safety Review (the Cumberlege report) in early July, which assessed the use of vaginal mesh, sodium valproate and Primodos and their associated under-acknowledged complications, this week we discuss trust between patients and doctors, and how that relationship of trust can break down when patients feel that their concerns and their pain are not being recognised and supported. We talk about the influence of racial inequalities on trust and healthcare outcomes, GPs being an advocate for their patients, and we ask what structural changes to the healthcare system need to happen to allow us to spend more time with our patients and build up that trusting relationship with them?

Our guests:

Karen Praeter works on the admin team of Sling the Mesh, a campaign which raises awareness of the risks of having a vaginal mesh implant, having joined two years after her own mesh implant operation in 2015 which led to painful complications.

Rhea Boyd is a paediatrician at the Palo Alto Medical Foundation in California, and she is also a public health advocate and scholar.

Lockdown has been such a stressful period that many healthcare professionals developed abnormal behaviours to cope. Addiction is one such behaviour, be it to a substance – alcohol for example – or any other obsessive activity like exercise. Dr Caroline Walker, an NHS psychiatrist and therapist who has personal experience of addiction discusses the harmful behaviours to look out for and what to do about them.

This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans.

We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year.

In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to Marian Knight, lead author of the ANODE trial - The BMJ's research paper of the year.

For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/

This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans.

We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year.

In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to David Pencheon, director of the NHS sustainability unit about his work.

For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/

As the pandemic play out, we’ve seen ways in which the collection of covid data - and it’s sharing, has been flawed, with reports in the UK that local authorities haven't got granular data, and in the US that the CDC is being circumvented for data reporting.

Kathleen Bachynski, assistant professor of public health at Muhlenburgh College, and Sridhar Venkatapuram, director of global health education & training at King's College London join us to discuss why data is fundamental to the social contract between the public and their government, and why undermining it is so dangerous.

Vaccines have been in the news this week - but when you dig into the stories, it turns out that the hype is about phase 1 trials. We're a long way from being sure any of the 150 possible vaccines being developed actually work.

In this talk evidence we're talking to a researcher, a regulator, and a manufacturer about the way in covid-19 is upending normal vaccine development, which hurdles they'll have to reach to get onto the market, and how we'll know which one to choose when they are there.

This week

(1.10) We said that covid would have a knock-on effect on other treatments, and Helen looks at some research into acute coronary syndrome admissions in the UK.

(6.53) Peter Doshi, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy and an editor for The BMJ, tells us what to watch out for in the PICO for a vaccine study.

(15.20) Marco Cavaleri, head of Biological Health Threats and Vaccines Strategy at the European Medicines Agency, explains what regulators are looking for when thinking about licencing a vaccine - and how covid has made different agencies around the world align their requirements.

(22.22) Philip Cruz, UK head of vaccines at GSK, explains how a manufacturer tests their vaccines, and how they use adaptive study design to past regulatory hurdles and provide information for those choosing which vaccine to use.

Reading list

Lancet paper - COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext

ONS Data - Deaths registered weekly in England and Wales, provisional: week ending 3 July 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest

The BMJ editorial - Vaccines, convalescent plasma, and monoclonal antibodies for covid-19 https://www.bmj.com/content/370/bmj.m2722

WHO report - Draft landscape of COVID-19 candidate vaccines https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

Research Methods & Reporting The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design https://www.bmj.com/content/369/bmj.m115

The signs and symptoms of racism have long permeated our society, and are embedded in our clinical practice and medical education. Recent events in the US, including the murder of George Floyd, have brought the Black Lives Matter movement to the fore of public consciousness, and have sparked outrage and protests in countries around the world. COVID-19 has exposed the inequalities in our healthcare systems, as the virus has had a disproportionate impact on some ethnic minority communities. In this week’s episode, we discuss colonial undertones to contraception policy-making, how doctors remaining silent on racial issues are seen as complicit, and the lack of diversity in learning resources used in medical schools. How can we use the current climate as a teaching moment to engage with people, clinicians and patients, about their experiences of healthcare? And how do we begin to make reparations in medicine for centuries of institutionalised racism?

Our guests: Annabel Sowemimo is a community Sexual & Reproductive Health registrar, working in Leicester. She is also the founder of Decolonising Contraception and a trustee for Medact charity. Shani Scott works as a general internist at Montefiore Medical Center in the Bronx. She is an associate program director for the Moses-Weiler Internal Medicine Residency Program, and is also the co-director of Diversity & Inclusion for the Department of Medicine at Montefiore Medical Center. Joan Saddler OBE is the director of partnerships and equality at the NHS Confederation, and the co-chair of the NHS Equality & Diversity Council. She was awarded an OBE in 2007 for services to health and diversity.

Resources mentioned by Jenny:

NEJM Perspective, "How Medical Education is Missing the Bull's-eye" by LaShyra Nolen https://www.nejm.org/doi/full/10.1056/NEJMp1915891

America Did What?! Podcast with Blair Imani & Kate Robards Episode 1: Redlining and the GI Bill https://www.stitcher.com/podcast/america-did-what

A series of medical scandals prompted Jeremy Hunt, former UK health secretary to launch the Independent Medicines and Medical Devices Safety Review - with the explicit aim of strengthening the patient voice in order to help build a "system that listens, hears and acts – with speed, compassion and proportionality"

That report is out, and describes a system that does anything but.

In this podcast, Sir Cyril Chantler, the review's vice chair discusses their recommendations, for better regulation, transparency and patient advocacy in the use of medicines and medical devices.

Read the full report: https://www.immdsreview.org.uk/

The BMJ report into what we must learn from mesh https://www.bmj.com/content/363/bmj.k4254

US President Donald Trump has been pushing hard for an American vaccine against Covid-19. He's named the program Operation Warp Speed, which has many people worried that safety tests will be rushed.

What are the prospects for an American vaccine against Covid-19? If the US is first, will it make its vaccines available to other countries? And what if it's not first?

Three American vaccine experts talk with the BMJ about prospects for an American vaccine against the new coronavirus.

Joining us are; Nicole Lurrie - senior lecturer at Harvard Medical School and a strategic adviser to the foundation working on global vaccines, CEPI.

Paul Offit - professor at the University of Pennsylvania, and co inventor of a rotavirus vaccine.

Prashant Yadav - senior fellow at the Centre for Global Development and a lecturer at Harvard Medical School.

We all know that healthcare professionals are stretching themselves to provide the care that’s needed right now. But there are instances when you might find yourself out of your comfort zone or being pushed too hard or fast. When is it ok to say no to these demands?

We spoke to Kate Burnett who educates NHS staff on empowerment about how to voice your position clearly and how to reconcile the guilt you might feel of letting the side down.

www.bmj.com/wellbeing

In this week's Talk Evidence we're hearing about how the death rate has dropped below average, disappointment about HIV drugs for covid-19 treatment, a trial to reduce polypharmacy, and why academic promotions matter to everyone else.

1.35 - Carl gives us one of his death updates

3.30 - Helen asks if it’s finally time to be able to do the international comparisons we’ve been waiting for?

16.10 - New research suggests that extreme PPE prevents transmission - but PPE came with a whole range of other viral suppression measures, and they all work together.

21.30 - The Recovery trial has said that lopinavir-ritonavir isn’t effective against covid - enough for them to stop the arm of that trial. We talk about this and more treatment evidence.

24.00 - Can a digital intervention reduce poly pharmacy? A new trial on bmj.com says no, but we talk about the composite endpoint and the way the trial is powered.

36.25 - Why academic promotion matters to non academics

The relaxation of the COVID-19 lockdown regulations is raising a lot of questions, both for doctors and for patients. This week, we discuss how the lack of clarity and coherence in public health messages over the past few months has caused anxiety and confusion for our patients, especially those who have been told to shield. We talk about GPs tailoring shielding advice to suit the individuals they treat, the politicisation of mask wearing, and the flaws of ‘abstinence-only’ health messaging. How do we balance prompting overall health, rather than just working to prevent disease, and how do we start taking baby steps towards returning to normality?

Our guests: Julia Marcus is an infectious disease epidemiologist and Assistant Professor at Harvard Medical School’s Department of Population Medicine . She is also an HIV researcher.

Carol Liddle, a COPD patient, is a patient advocate on the panel for NACAP (National asthma and COPD audit), as well as a patient representative for the Taskforce for Lung Health, which is run by the British Lung Foundation.

Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

For a long time, the BMJ has been interested in conflicts of interest and how that skews the research base.

We also heard in our podcast on "Big Tan" that science is being used to sow seeds of doubt into the association between sunbeds and skin cancer, by scrutinizing the minutiae of a research paper, but ignoring it's bigger message.

Now it's all just happening in medicine. This is an industry tactic. And to talk about that we're joined by David Michaels - who was the longest serving head of the Occupational Safety and Health Administration, and an epidemiologist and professor at the George Washington University School of Public Health.

Read The BMJ's collection - Commercial influence in health: from transparency to independence https://www.bmj.com/commercial-influence

To find out more from David, plus his two books on the influence of industry https://www.drdavidmichaels.com/

In the third part of our series of podcasts “Corona Virus as Seen Through a US Lens,” features editor for The BMJ, Joanne Silberner, talks to Dr. Adeline Goss about the experience of being a new mom and a hospital resident during the crisis.

In The BMJ, Dr Goss recently wrote about the challenges facing medical residents as they deal with working during the virus.

When she went on maternity leave a few months ago, nothing seemed amiss, beyond the normal stress of being a new mom. But when she returned to full time work on June 1, everything had changed. Goss kept an audio diary of her experience preparing and going back to work and we hear some of that during the podcast.

For more of The BMJ's covid-19 coverage www.bmj.com/coronavirus

This week we're looking beyond the press release for dexamethasone, the long awaited review of antibody testing, and how well people are recovering after surviving acute covid-19.

(2.36) The preprint for dexamethasone is finally out - considerably after the press release. Carl digs into it to find out how good the news actually is.

(8.49) There are a couple of newly published systematic reviews on antibody testing, so we return to our testing guru Jon Deeks - professor of biostatistics at the University of Birmingham to give us an update.

(23.52)Covid-19, it became apparent as the pandemic grew, was more than a respiratory disease - there are systemic effects on almost all organs. As people are recovering from the worst ravages of the disease, the long term consequences of those effects are becoming more clear - Lynne Turner-Stokes, professor of rehabilitation medicine at King's College London.

Reading list;

Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1

Cochrane review of antibody tests for covid-19 DOI: 10.1002/14651858.CD013652

British society of rehabilitation medicine guidelines for rehab after covid-19. https://www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf

In this week’s episode, our focus is on what the post-COVID world of general practice might look like. The pandemic has exposed the inequalities in our social and healthcare systems, but has also given GPs some much-needed headspace to reflect on changes to make going forward. Will we be able to turn general practice off and on again, like a faulty computer? Will we just drift back to the status quo, or will we seize this opportunity to shake up the old routines in order to redefine the role of the GP and to benefit the ever-evolving needs of our patients?

Our guests:

Martin Marshall is Chair of the Royal College of General Practitioners, a professor of Healthcare Improvement at UCL, and a GP practising in East London.

Jenny Doust is a Clinical Professorial Research Fellow at the School of Public Health at the University of Queensland, and practises as a GP in Brisbane.

Toyin Ajayi is Chief Health Officer, and co-founder, of Cityblock Health, which is a New York-based health and social services company delivering personalised healthcare to marginalised communities.

Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

Earlier this year, the bmj published a racism in medicine issue - the issue was guest edited by Lord Victor Adebowale, chief executive of the NHS Confederation and Professor Mala Rao, professor of public health at Imperial College London.

At the event to launch the issue, they managed to persuade Simon Stephens , chief executive of the NHS, to put money into a “race in health observatory”

Mala joins us to talk about what that observatory is going to do, how it will maintain independence, it's role in synthesising, commissioning and implementing research, and where the organisation might begin in tackling the issue.

Reading list NHS launches Race and Health Observatory after BMJ’s call to end inequalities https://www.bmj.com/content/369/bmj.m2191

The BMJ's racism in medicine issue (free to access) https://www.bmj.com/racism-in-medicine

Interview with Yvonne Coghill https://podcasts.apple.com/us/podcast/yvonne-coghill-is-trying-to-fix-racism-in-the-nhs/id283916558?i=1000466962555

Interview with David Williams https://podcasts.apple.com/tr/podcast/david-williams-everyday-discrimination-is-independent/id283916558?i=1000465493980

n normal times, around this time we’d start thinking about weekend breaks and summer holidays abroad. More than most healthcare staff and other key workers are in dire need of time out. Given the uncertainties around foreign travel, how can we recreate in some way that holiday feeling. Simon Calder, travel correspondent for The Independent newspaper, offers his staycation tips and alternative travel advice.

At the end of May, the WHO said that South America has become the new epicentre of the covid-19 pandemic.

The majority of those with covid are in Brazil - not entirely surprising given it is the most populous - but in neighbouring Peru, numbers are growing too.

And it’s to Peru that we turn to talk to our guest today, Valerie Paz-Soldan is a social scientist and director of the Tulane Health Office for Latin America - part of the university’s school of public health and tropical medicine.

She joins us to talk about the pattern of the virus in Peru in particular, but elsewhere in the region, and how the pandemic is overwhelming an already stressed healthcare system.

https://www.bmj.com/coronavirus

This week, we’re asking questions about surgisphere data, and how it might have got into such high impact journals, we’re also talking about the protests around the world about structural racism - and how they intersect with the covid pandemic.

(1.39) Helen and Carl talk about the data underlying the newly retracted papers on hydroxychloroquine and ace-inhibitors or ARBs and covid.

(7.45) Fiona Godlee, the BMJ’s editor in chief, comes onto the pod to talk about retractions, and why they’re often called for, an rarely done.

(25.10) We talk about the protests, and Carl gives us his opinion on the risk of covid transmission during them (spoiler; he thinks it’s low)

(37.40) Sonia Saxena, professor of primary care at Imperial College London gives her verdict on the Public Health England report into this disproportionate effect of covid on ethnic minorities in the UK, and pushes back against it being a biological instead of a sociological determination.

Reading list:

Sonia’s analysis into transforming the health system for the UK’s multiethnic population https://www.bmj.com/content/368/bmj.m268

News Analysis - Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ https://www.bmj.com/content/369/bmj.m2264

The PHE report into the disparate risk of covid to ethnic minorities https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes

How might Burmese Buddhism help deal with pandemic stress? Christopher Bu drew on his familial heritage and the tradition of practicing mindfulness to cope with the stresses of studying to be a doctor. He invites us to consider how the same techniques might be useful psychological tool for all healthcare workers during this challenging time.

In this episode of Talk Evidence, we'll be finding out if second waves are inevitable (or even a thing), how the UK's failure to protect it's care homes is symbolic of a neglected part of public life, and why those papers on hydroxychloroquine were retracted.

This is Talk Evidence - the podcast for evidence based medicine, where research, guidance and practice are debated and demystified.

Helen Macdonald, UK research editor for The BMJ, and Carl Heneghan, professor of EBM at the University of Oxford and editor of BMJ EBM, talk about some of the latest developments in the world of evidence, and what they mean.

This week:

2.00 - Helen looking into a second wave - and finds out from Tom Jefferson, an epidemiologist with the Cochrane Collaboration's acute respiratory infections group, that a "wave" might be a misnomer.

12.00 - Mary Daly, professor of sociology and social policy at the University of Oxford, tells us where the UK went wrong with care homes, and what we’d need to do to stop it happening again.

31.20 - Carl and Helen discuss those hydroxy chloroquine papers, now retracted. This was recorded before that happened, but we decided to keep this section in, because they talk about the reasons the papers should be viewed with caution, and the importance of scrutiny of the data.

Reading list: The talk from Mary Daly at Green Templeton College. https://www.gtc.ox.ac.uk/news-and-events/event/covid-19-and-care-homes-what-went-wrong-and-why/

The Trump administration was left a playbook for pandemics when they entered the Whitehouse, but even before covid-19 was a threat systematically dismantled the public health protections put in place to follow that playbook.

In this podcast, Nicole Lurie, Gavin Yamey and Gregg Gonsalves talk about how the US response to public health was mismanaged, how it has become politicized, and what that playbook suggested should have been done. They also talk about rebuilding public health in the US after this is all over.

Our guests; Nicole Lurie, former Assistant Secretary for Preparedness and Response under the Obama administration, senior clinical lecturer at Harvard Medical School and advisor to the Coalition for Epidemic Preparedness Innovation Gavin Yamey, professor of global health and public policy at Duke University Gregg Gonsalves, assistant professor of epidemiology at Yale School of Public Health.

This podcast is hosted by Joanne Silberner.

For GPs, testing patients is their “bread and butter”. This week, we discuss the “better safe than sorry” attitude towards testing, which is so common among doctors – are we guilty of over-testing purely out of force of habit, or are we worried about missing something vital, and therefore find reassurance in doing them? How should we interpret test results, and how do these results affect the way we manage our patients? And, with the huge focus on COVID-19 testing in the media, how do we communicate the current risks and uncertainties surrounding it to our patients?

Our guests: James McCormack is a professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia, and the co-host of a popular weekly podcast called Best Science (BS) Medicine podcast. His work focuses on helping healthcare professionals to understand medical data, by taking the best available evidence and making it as simple and practical as possible.

Jess Watson is a GP, working in Bristol, and an expert on medical testing. She is a researcher with an interest in the use of diagnostic tests in primary care, specifically inflammatory marker blood tests.

Reading list: James's BS Medicine Podcast https://therapeuticseducation.org/

Jess's Practice Pointer - Interpreting a covid-19 test result https://www.bmj.com/content/369/bmj.m1808

That remdesivir study has finally been published - what does it say and is it as independant as claimed. Also, as the world's focus turned to covid, so have researchers - and they've produced over 15000 papers. How can we sift through the flood of research and know what's any good?

(2.30) Helen Macdonald talks to Elizabeth Loder about the volume of research we're seeing, and why journals and peer reviewers are struggling to check it all.

(8.15) The study on remdesivir has been published - the trial was stopped early, and the primary outcome switched - we talk about how that increases uncertainty over the results, and could actually delay the treatment.

(26.50) We hear from a couple fo readers who wanted to correct us about averages, means, medians.

Reading list: The US NIH AID study on remdesivir, published 22nd May in the New England Journal of Medicine

Research - preliminary report https://www.nejm.org/doi/full/10.1056/NEJMoa2007764 NEJM - looking at the dose duration https://www.nejm.org/doi/full/10.1056/NEJMoa2015301 Editorial - an important first step https://www.nejm.org/doi/full/10.1056/NEJMe2018715

Non covid content alert

While the last couple of months have been covid-19 focused, the work of the beforetimes carries on - including a topic the BMJ is perennially interested in, industry funding of medics.

Ray Moynihan, researcher at Bond University, has been looking at financial ties between some healthcare association leaders, and industry, in the US, and reports that in new research published this week in The BMJ.

Read the full open access research;

Financial ties between leaders of influential US professional medical associations and industry: cross sectional study - https://www.bmj.com/content/369/bmj.m1505

How might stress affect your performance as a healthcare worker?

That’s the question that Mark Stacey, a consultant obstetric anaesthetist in Cardiff, has been interested in for the past 10 years. He saw similarities in the aviation industry, which uses a theory of human factors to explain why things go wrong when humans interact with complex systems.

Stress was a major culprit, in both aerospace and medicine, so he began to explore wellbeing as a way to reduce stress and, in turn, reduce adverse events. He has developed the idea of writing yourself a wellbeing prescription, which includes practical techniques such as the Baker’s Dozen and a gratitude diary.

Useful tools

Bakers Dozen https://www.cardiff.ac.uk/__data/assets/pdf_file/0003/808950/Bakers-Dozen-Toolkit.pdf

A 30 day plan that Mark has put together http://www.cardiffandvaleuhb.wales.nhs.uk/improving-resilience-in-anaesthesia

This last week has seen questions raised about the integrity of some of the epidemiological data being produced by US states, and as rates continue to grow in some countries international comparisons are being questioned.

To discuss the implication of that are;

Sridhar Venkatapuram associate professor global health & philosophy at King's College London Kathleen Bachynski Assistant professor of public health at Muhlenberg College

Martin Mckee Professor of European health at the London School of Hygiene and Tropical Medicine

This week we're focussing on what kind of information we need to be able to collect and use as the country transitions out of lockdown - and why local lockdowns may be here for some time.

We also hear about the new antibody tests which are available in the UK - are they actually a game changer?

(2.00) Helen explains what some new evidence says about hydroxychloroquine (spoiler; don’t take it for covid-19)

(6.40) Non covid alert - Carl tells us about new research on compressions stockings for thromboprophylaxis, and the importance of doing research on non-pharmacological interventions

(10.30) David Nabarro, Special Envoy of WHO Director-General on COVID19,

(28.00) Helen goes back to Jon Deeks, professor of biostatistics at Birmingham, to find out more about these “accurate” tests for covid, endorsed by the government this week.

Reading list:

Clinical efficacy of hydroxychloroquine in patients with covid-19 https://www.bmj.com/content/369/bmj.m1844

Hydroxychloroquine in patients with mainly mild to moderate covid-19 https://www.bmj.com/content/369/bmj.m1849

David Nabarro’s website, with daily briefings https://www.4sd.info/

News Covid-19: Two antibody tests are “highly specific” but vary in sensitivity, evaluations find https://www.bmj.com/content/369/bmj.m2066

With COVID-19 still ongoing, and at the forefront of the minds of doctors, patients and members of the public alike, difficult conversations are taking place - GPs are encouraged to talk about death with those who might not be ready to discuss it, and families are losing loved ones without being able to say goodbye. In this episode, we also look at survivor guilt, the range of emotions that grieving encompasses, and how to address the potentially thorny subject of advance care planning with COVID-19 patients.

Our guests: Katherine Shear, internist and psychiatrist, is Director of The Center for Complicated Grief at Columbia University’s School of Social Work. She has been involved in research into treatments for grief for over 20 years.

Scott Murray, a recently retired GP, has key interests in disease trajectory and advance care planning. He led the first Primary Palliative Care Research Group and he chairs the International Primary Palliative Care Network. He advocates high-quality palliative care for everyone.

This week's deep breath out is the Viral Counterpoint of the Coronavirus Spike Protein (2019-nCoV) - https://soundcloud.com/user-275864738/viral-counterpoint-of-the-coronavirus-spike-protein-2019-ncov

Does history count as a non-pharmaceutical intervention? Much of our view on what to do in this pandemic has been influenced by the 1917 Spanish 'flu outbreak - even though covid-19 seems to be acting differently.

In this podcast, we talk to Howard Markel, a professor of pediatrics at Michigan, as well as professor in the history of medicine. He's written books on quarantines and epidemics, and was part of a team that did the medical and historical work that first showed the value of flattening the curve.

This is the first of 4 podcasts from our US colleagues, looking at the disease in that country, which will be published over the next 2 months.

For more on covid-19 www.bmj.com/coronavirus

Hydroxychloroquine is in the news again - as Trump and some news organisations are pushing it as a treatment, despite evidence (published in The BMJ) showing it lacks efficacy, and has a load of potential negative effects - including arrhythmias.

We know that kind of information spreads online - particularly through social media, but how does it do that?

In this podcast we talk to Adam Kucharski, and epidemiologist from the London School of Hygiene and Tropical Medicine, who has used disease modelling tools to look at fake news spread, and has some ideas about creating an online social distance.

For more covid coverage www.bmj.com/coronavirus

Big data is being crunched to help us tackle some of the enormous amount of uncertainty about covid-19, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

In these podcasts, we're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week.

(3.10) Calum Semple, professor of outbreak medicine at the University of Liverpool talks about the ISARIC project - predesigned research brought off the shelf and deployed during a pandemic.

(14.20) Ben Goldacre, doctor, researcher and director of the EBM datalab at the University of Oxford, joins us to talk about how his team have managed to pull together records from 40% of NHS patients to look for patterns in covid-19 morbidity and mortality.

Reading list

OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1

Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1

If you’re a regular listener to our podcasts, you’ll have heard how Covid is exposing the cracks in our systems of healthcare - from showing how poorly provisioned elderly social care is, to how antibody testing issues have exposing how innovation is uncoordinated and driven by the worst bits of the free market.

In this podcast we talked to Soumya Swaminathan, the WHO’s first Chief scientist, and ask about how the world’s foremost normative body for health tackle some of this issues.

We talk about agenda setting - and how the WHO is trying to prioritise neglected areas of research, how they’re starting to set standards for evidence driven by public rather than commercial priorities, and how, if and when a vaccine for corona virus is finally created - they can help it be distributed equitably, rather than to those with the most money to spend.

The first peak of the pandemic has passed, the situation in hospitals is more manageable. While healthcare workers are preparing for the long haul, Abi and Cat discuss how to deal with this period of post-crisis crash.

In this podcast, we speak to Ali Milani, a former Labour politician who ran against Prime Minister Boris Johnson in his London constituency during the 2019 election. How might Milani’s experience of a year-long campaign and fallout compare to the current post-emergency stage of Covid-19?

www.bmj.com/wellbeing www.bmj.com/coronavirus

We’re at the point in the pandemic that restrictions on the way people live and work are being relaxed around the world, but how that changes safety for the population is very different depending on your demographic - will you have to work with other people, will you have to take public transport to work, and can you wear a mask in public safely?

To talk about the importance of not neglecting those most affected by covid-19 we’re joined by Kathleen Bachynski, assistant professor of public health at Muhlenberg College and Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London

For all The BMJ's covid coverage www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week:

(1.20) Carl gives us an update on the England and Wales admission data.

(3.00) Helen talks about ways in which spread and severity of infection amongst household contacts.

(8.20) We talk natural history of covid-19, and Harlan Krumholz, cardiologist at Yale, tells us what we know, and why it's difficult to have a full picture at the moment.

(15.10) Helen picks up on a study from Tim Spectre and colleagues using an app to track cases.

(20.00) Henry Scowcroft, one of The BMJ's patient editor, who also works for Cancer Research UK, joins us to talk about patients who are taking part in clinical trials, and how this is affecting them. He also touches on the thin patient participation in the design of covid treatment guidelines.

(24.10) Carl talks rapidity of publishing, and where researchers should most target their evidence outreach.

Reading list: Reducing risks from coronavirus transmission in the home https://www.bmj.com/content/369/bmj.m1728

Rapid implementation of mobile technology for real-time epidemiology of COVID-19 https://science.sciencemag.org/content/sci/early/2020/05/04/science.abc0473.full.pdf

The BMJ Public and Patient participation twitter chat https://twitter.com/hashtag/BMJdebate

We are more than six weeks into the lockdown and if you were to gauge the mood of the nation, it would be one of fatigue. It started as an all-hands-on-deck emergency situation, but it now transpires that the current work situation for healthcare professionals is not going to change any time soon.

This is a marathon rather than a sprint. So how can we better look after ourselves to cope with this new realisation? In this podcast we speak to Dr Caroline Walker, an NHS-based psychiatrist and therapist.

Wait til the end for Caroline's simple technique she uses to help when feeling overwhelmed.

Read Caroline and Clare Gerada's opinion piece https://blogs.bmj.com/bmj/2020/03/31/extraordinary-times-coping-psychologically-through-the-impact-of-covid-19/

In this week’s episode, we discuss bystander guilt, convergence, brain hacks and “how you can sneeze on someone’s brain from anywhere in the world”. How can GPs cope with the myriad worries around treating patients during the current pandemic, both on the frontline and in general practice? How do we recognise and break unhelpful anxious behaviour habits and stop fixating on the news?

Our guests:  Monica Schoch-Spana is a medical anthropologist and a Senior Scholar at Johns Hopkins Center for Public Health. She specialises in crisis and risk communication, community resilience to disaster, public engagement in policy-making and public health emergency preparedness.

Jud Brewer is an addiction psychiatrist and neuroscientist, specialising in anxiety and habit change. He is the Director of Research and Innovation at Brown University’s Mindfulness Center, an associate professor of behavioural and social sciences at the School of Public Health at Brown, as well as of psychiatry at the university’s medical school.

Reading list:  Monica's blog on the psychological impacts of covid-19  https://blogs.scientificamerican.com/observations/covid-19s-psychosocial-impacts/

Jud's article in the New York Times https://www.nytimes.com/2020/03/13/well/mind/a-brain-hack-to-break-the-coronavirus-anxiety-cycle.html

GP course: https://drjud.com/health-care-provider-course/

Youtube animation of the NYTimes article: https://www.youtube.com/watch?v=900cOKCADIk&feature=youtu.be

Youtube coronavirus daily videos: https://www.youtube.com/watch?v=w4NwsyXRbNw&list=PL6sRqjtLfiTTni7oXKpSj2cQ9290lkpKH

As the pandemic plays out - hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed.

How are these affecting care for those who are in hospital but don't have covid-19?

In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in intensive care medicine and Partha Kar, consultant in diabetes and endocrinology in Portsmouth, join us to discuss how their working week is changing.

Read the BMJ's columns https://www.bmj.com/uk/news/views%20%26amp%3B%20reviews

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week: (1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted.

(2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be.

(6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information.

(11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how some research is being done behind a veil of confidentiality.

(35.27) When there's a lot of uncertainty, and the stakes are very high, then tempers can flare. Vinay Prasad, hematologist-oncologist in the US, and host of Plenary Sessions podcast, joins us to talk about having a good, respectful, scientific debate.

How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it.

In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her colleagues working at the frontline, and how that initiative inspired others and mushroomed across the UK.

Around the world, as the covid pandemic plays out, and some countries are starting to ease their restrictions, this narrative of the economy and public health being opposing weights on a set of scales keeps returning - they need to be balanced.

But before this, a healthy population is very much seen as being supportive of the economy. So is a pandemic different, or is that dichotomy false.

Joining us to discuss are;

Martin Mckee, professor of european health at LSHTM Kathleen Bachynski, assistant professor of public health at Muhlenberg College Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London

As the pandemic plays out - the way in which doctors in the UK practice is changing, hospitals are reconfigured to increase critical care capacity, GPs are working from home and doing their day to day work remotely.

Some of the changes have come at the detriment of staff and patient wellbeing but covid-19 has also helped cut through some of the inertia to get welcome changes done.

In this podcast, Helen Salisbury, GP in Oxfordshire, and Clare Gerada, GP in south London, join us to talk about the way in which general practice has changed, and how they and their teams are experiencing that.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.

There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week:

(1.00) Carl gives us an update on the UK’s covid-19 related mortality

(7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF.

(25.37) Update on covid-19 research, looking at viral particle shedding.

(29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s already seen, and ways in which it could be avoided.

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported.

Subscribe on; Apple podcasts - https://bit.ly/applepodsDBI Spotify - https://bit.ly/spotifyDBI Google podcasts - https://bit.ly/googlepodsDBI This week, our topic is fear: we try to get a better understanding of fear, how it affects all of us as clinicians for better or for worse, and the impact that fear has on the ways in which we approach our patients & practice. Does fear distort our judgement, and increase the likelihood of blundering, or does a healthy dose of fear help to keep us grounded?

Our guests:

Iona Heath is a former GP and president of the Royal College of GPs. Danielle Ofri is an internist at Bellevue Hospital in New York, and Clinical Professor of Medicine at NYU School of Medicine. She has written several books on topics such as medical error and how doctors’ emotions affect their practice.

The Deep Breath Out - The bees of Brockwell Park Surgery

https://www.bmj.com/podcasts/deepbreathin

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported.

Subscribe on; Apple podcasts - https://bit.ly/applepodsDBI Spotify - https://bit.ly/spotifyDBI Google podcasts - https://bit.ly/googlepodsDBI

In our first episode, we discuss the highs and lows of video consultations, and how coronavirus has altered the landscape of business as usual for GPs. How will this change affect our relationships with our patients? How do we cope with frustrating technical issues? Are we more likely to miss a crucial diagnosis if we can’t rely on physical examinations? And, finally, are teleconsultations the future of GP practice?

Our guests:

Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford. Trish is a leading researcher on video consultations. Fiona Stevenson is a medical sociologist and researcher based at UCL. She is the co-director of their e-health unit.

Deep Breath Out - the Rob Auton Daily Podcast https://play.acast.com/s/robautonpodcast

https://www.bmj.com/podcasts/deepbreathin

There is no doubt that anxiety levels that clinicians are feeling during this pandemic are high.

One military medic believes the current situation is comparable to his experience when posted during British campaigns in Afghanistan and Iraq. Cormac Doyle offers advice on how to deal with high-stress conditions, both in a work and at home, as well as how to negate the future effects of post-traumatic stress disorder.

One strategy he supports is using Bilatural Stimulation using music, one example of which called “Strength Within” can be found here shorturl.at/fgrSW.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.

There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week:

(3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it

(13.22) Carl explains why smoking cessation is still a key public health priority under covid-19

(16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection.

(27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic)

Reading list.

Compassionate Use of Remdesivir for Patients with Severe Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

How can pandemic spreads be contained in care homes? https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-care-homes/

Covid-19: Death rate in England and Wales reaches record high because of covid-19 https://www.bmj.com/node/1024784.full

We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful.

But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips on how to change your communication for the situation.

She explains safety netting in telephone triage, note taking, and why there are some advantages to working that way.

www.bmj.com/coronavirus www.bmj.com/wellbeing

As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ?

In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're joined by David Oliver, consultant in geriatrics and internal medicine, and Matt Morgan, consultant in intensive care medicine.

Read the columns https://blogs.bmj.com/bmj/category/columnists/matt-morgan/ https://blogs.bmj.com/bmj/category/columnists/david-oliver/

For more free information on covid-19 www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.

There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week:

(2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped.

(12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful.

(26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold

Reading list: COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed-pneumonia

Chloroquine and hydroxychloroquine in covid-19 https://www.bmj.com/content/369/bmj.m1432

Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal https://www.bmj.com/content/369/bmj.m1328

What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covid-type-respiratory-illnesses-in-primary-care-staff/

As part of our response to the covid-19 pandemic, we’re going to be running a series of discussions with experts about some of the big issues arising from the virus.

In this one, we’re asking about the public health response to an outbreak - what’s necessary, and is it possible to go to far.

Joining us are Martin Mckee - professor of european health at the London Schoole fo Hygiene and Tropical Medicine

Kathleen Bachynski - assistant professor of public health at Muhlenberg College

Sridhar Venkatapura - associate professor global health & philosophy at King's College London

www.bmj.com/podcasts www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.

There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week

5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral

10.00 - The importance and difficulty of making guidelines now

15.00 - We hear from guideline maker Per Vandvik, about making guidance.

21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv.

31.10 - Testing. What are the tests, and when do we want specificity, and when do we want sensitivity. Nick Beeching from the Liverpool School of Tropical Medicine joins us to explain.

Reading list: www.bmj.com/coronavirus

Rapidly managing pneumonia in older people during a pandemic https://www.cebm.net/covid-19/rapidly-managing-pneumonia-in-older-people-during-a-pandemic/

https://www.medrxiv.org/

Covid-19: testing times https://www.bmj.com/content/369/bmj.m1403

Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now.

Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital.

In this podcast she reflects on the use of PPE, talks a little about the culture of it - and how overuse by one person can amply the concerns of others, the effect on patients of seeing their carers in protective equipment (especially children), and the importance of communication when you can't see colleagues faces anymore.

www.bmj.com/wellbeing www.bmj.com/coronavirus

Continuing our series on wellbeing during the pandemic, in this podcast we speak to Occupational Psychologist Roxane Gervais about how doctors can look after themselves during the covid-19 pandemic.

We discuss the importance of reaching out to friends and family during this difficult time, how to deal with the loss of control, as well how to tackle feelings of guilt when you are unable to work clinically.

For more wellbeing content www.bmj.com/wellbeing

For more on covid-19 www.bmj.com/coronavirus

We knew a pandemic was coming at some point - it’s kind of why we have the WHO. We have had various smaller scale tests of the international response to an infectious disease outbreak - Ebola in west africa being the most recent.

After that, reports criticised the WHO's response - citing problems around the swiftness of their action, the lack of coordination between countries, and the platforms for knowledge sharing. Is the agency doing any better in Covid-19?

Suerie Moon is co-director of the Global Health Centre at the Graduate Institute of International and Development studies in Geneva, and author of one of those critical reports which was published in The BMJ. She joins us to assess how the WHO is responding.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.

There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week

3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases.

10.30 - where are we with research into antiviral treatment

17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them.

29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is working with the Icelandic government to allow everyone to access testing for the virus.

Reports from Italy, and more recently from the U.S. show the strain the healthcare system is under during this pandemic.

We know that staff will step up in an emergency, but this isn’t a fire or a bombing, this is going to last for months. So how can organisations be proactive in supporting staff, and how can leaders try to mitigate the inevitable burnout.

In this podcast, Michael West, professor of organisational psychology at Lancaster university, and author of the GMC report “Caring for doctors, caring for patients” joins us to talk about what compassionate leadership looks like in a time of covid-19.

Resources www.bmj.com/coronavirus www.bmj.com/wellbeing www.bmj.com/podcasts

https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon.

As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).

in this episode (1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug?

(8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers.

(17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down

(21.25) Helen puts test results under a microscope, and finds out that they may vary.

(33.20) What do conflicts of interest in tanning papers mean for wider science?

(48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0.

Reading list: Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study https://www.bmj.com/content/368/bmj.l6968

Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1911793

Effect of dose and duration of reduction in dietary sodium on blood pressure levels https://www.bmj.com/content/368/bmj.m315

Your results may vary: the imprecision of medical measurements https://www.bmj.com/content/368/bmj.m149

Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review https://www.bmj.com/content/368/bmj.m7

Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies https://www.bmj.com/content/368/bmj.m127

The NHS is a world leader in sustainable healthcare - and it's the staff who have have been leading the charge.

The For A Greener NHS campaign is asking everyone who has made a change to the way they work, to submit evidence and help shape the whole organisation's response to the climate emergency.

In this podcast, Isobel Braithwaite, public health registrar & academic clinical fellow at UCL, and Sandy Robertson, LTFT Emergency Medicine Trainee and Chair of RCEM environmental specialist interest group, join us to explain what they're doing, and what kind of evidence is needed.

For more on the For A Greener NHS campaign https://www.england.nhs.uk/greenernhs/

To submit evidence https://www.engage.england.nhs.uk/survey/nhs-net-zero/

We all know we should be doing more exercise, and one way to do that is by active commuting - journeying to work on foot or by bike.

One thing preventing people from taking up cycling is the fear of being involved in road traffic accidents, and that the risk isn't worth the benefit of the extra exercise. It’s even more confusing when air pollution has to be taken into account.

Joining us to discuss new research into that risk/benefit calculation are Paul Welsh, a Senior Lecturer, and Carlos Celis, a research fellow, both Institute of Cardiovascular & Medical Sciences at the University of Glasgow.

Read their open access research - Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study https://www.bmj.com/content/368/bmj.m336

We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems.

The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care lacks coordination, and isn't as good as it should be.

To look at why patients with multiple conditions pose a challenge to the NHS, and what we can do to improve the care they receive, we’re joined by

Louella Vaughan, acute physician and senior clinical fellow at the Nuffield Trust Jihad Malasi, GP and clinical chair of Thanet CCG Rammya Mathew, GP and a quality improvement lead and columnist for The BMJ and David Oliver, consultant in geriatrics, clinical vice president of the RCP and columnist for The BMJ

In this week's special episode of Sharp Scratch, we've got something a little different for you! Last week the panel talked microaggressions, so this week we're hearing from an expert guest who is leading the work the NHS is doing to combat inequality in healthcare.

If you like this special edition, let us know on Facebook, Instagram or Twitter using #SharpScratch

This week's special guest:

Yvonne Coghill, CBE is the director of Workforce Race Equality Standard (WRES) at NHS England and NHS Improvement. Yvonne has over 20 years’ experience in nursing, before taking up operational and strategic leadership posts.

During her 40 plus years career, she has held a wide variety of clinical and managerial roles at the Department for Health and NHS Leadership Academy. In 2013 she was voted by colleagues in the NHS as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 black and minority ethnic (BME) pioneers, two years in a row.

In July 2015 Yvonne joined NHS England as director for WRES Implementation. She was awarded an Order of the British Empire for services to healthcare in 2010 and Commander of the British Empire in 2018. Yvonne was elected deputy president of the Royal College of Nursing (RCN) in November 2018.

Some of the resources Yvonne mentions during the interview:

https://www.england.nhs.uk/2020/02/nhs-publishes-new-workforce-race-equality-data-ahead-of-nhs-and-race-summit/

https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/resources/

https://www.england.nhs.uk/2019/01/race-equality/

Last week the BMJ published it’s first special edition into Racism in Medicine. The issues tacked ranged from differential attainment in medical school, to the physiological effects that experiencing everyday discrimination has.

The issue was guest edited by Victor Adebowale, the Chief Executive of the social care enterprise Turning Point, and Mala Rao, Professor of Public Health, at Imperial College London - and they, along with Simon Stevens, chief executive of the NHS, Chand Nagpul Chair of council of the BMA, and the Olalade Obedare, medical student from Nottingham University Medical School, talked at the event.

www.bmj.com/racism-in-health.

We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China.

With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns.

In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

(8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19

(17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease.

(20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses.

(30.00) We discuss treatment options in the face of massive uncertainty.

To read more about covid-19 and to keep up to date with the disease visit https://www.bmj.com/coronavirus where all of the information on the disease if freely available.

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK.

David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health.

He’s shown that people who experience every day acts of discrimination— like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality.

In this podcast he is interviewed by Lilian Anekwe, assistant news editor for New Scientist.

Read Lilian's article on tackling racism in the NHS https://www.bmj.com/content/368/bmj.m341

And all of the special issue on racism in medicine https://www.bmj.com/racism-in-medicine

In 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds.

That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work - and in this podcast I talk to Eleni and her colleagues Stanton Glantz, and Yogi Hendlin about what they’ve uncovered.

Reading list: Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning https://www.bmj.com/content/368/bmj.m7

Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis https://www.bmj.com/content/345/bmj.e5909

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters.

However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of Medical Royal Colleges' lay patient committee, suggest that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams.

Read their article explaining what makes for a good outpatient letter; https://www.bmj.com/content/368/bmj.m24

In October 2019, Mary Dixon-Woods, director of the THIS Institute, dedicated to healthcare improvement. In that she explained how she believed healthcare improvement could be improved.

The essay took the position that "Quality Improvement" isn't necessarily the best way to improve healthcare, and that more rigour needs to be brought to the field.

That paper has created a great deal of discussion, so in this podcast we wanted to go back to Mary and ask her what she thinks about improvement, and how we can practically put into place some of the things she calls for.

Read the full essay: https://www.bmj.com/content/367/bmj.l5514

And the rest of our healthcare improvement series: https://www.bmj.com/quality-improvement

Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of call is the GP.

In this podcast, Steven Bradley GP, and Neil Lawrence, paediatric trainee join us to discuss how common precocious puberty is, how GPs should respond to a family presenting with it, and if intimate examination is actually warranted in primary care.

Read the full practice pointer: https://www.bmj.com/content/368/bmj.l6597

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)*

This month:

(1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice.

(4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients.

(11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc.

(17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it?

(33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot.

Reading list:

Corticosteroids for Treating Sepsis in Children and Adults https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-treating-sepsis-in-children-and-adults/?dopt=Abstract

Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline https://www.bmj.com/content/368/bmj.l6722

Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. https://www.ncbi.nlm.nih.gov/pubmed/31910280

Blinding Fool’s gold? Why blinded trials are not always best https://www.bmj.com/content/368/bmj.l6228

Impact of blinding on estimated treatment effects in randomised clinical trials https://www.bmj.com/content/368/bmj.l6802

*quick note to say sorry about the sound quality on Duncan's microphone - we had a technical glitch (he was left alone to record).

In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died.

51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy.

In this podcast we’re joined by Daniel Mulrooney, associate professor in the Division of Cancer Survivorship, at St Jude Children’s Research Hospital and one of the authors of the paper Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort

Read the full research:

https://www.bmj.com/content/368/bmj.l6794

Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com.

The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them.

Suerie Moon, co-director of global health at the Graduate Institute of Geneva joins us to explain what's wrong with how we decided what to pay for medicine's now, and how we could change that.

Read the full collection: https://www.bmj.com/fair-pricing

Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff.

The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary interventions such as resilience training.

In this podcast interview, he describes what he found - and talks about how low wellbeing is amongst doctors, why the command and control nature of some management teams has increased the problem, and why he has hope because of some of the good practice he sees in NHS organisations.

Read the full report: https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

If you read the Christmas BMJ in the last few weeks, you might have noticed a lot around art and health - the way in which engagement in arts can help in prevention and treatment, but can also affect those more nebulous things which really matter to patients - loneliness, self expression, being connected to the wider community.

That obviously links to social prescribing, which looks like it’s going to be one of the big changes to medicine which will happen in near future.

In this podcast we hear from Simon Opher, a GP in gloucestershire who has had artists and poets in residence in his surgery, and has experience of setting up services which link art and health - and we discuss how to do that practically. SImon makes it sound easy, but also has a few tips for GPs out there who have an idea about a non-medical service that could help their patients, but doesn’t yet exist.

We’ll also be talking to Helen Stokes Lampard, former chair of the Royal College of Surgeons and head of the new National Academy for Social Prescribing - as services bloom, how do we know what actually works?

Helen is sceptical that our current ways of evaluating an intervention are going to be inadequate to look at the much more messy world of social prescribing, with it’s localisation, multitude of influences, and difficult to measure outcomes.

Reading list: Previous BMJ podcast on social prescribing https://podcasts.apple.com/no/podcast/social-prescribing/id283916558?i=1000446265663

Clinical update on social prescribing https://www.bmj.com/content/364/bmj.l1285

If you’re lucky enough to not be back at work, you might be feeling like you need to quickly refresh your medical knowledge - and this podcast the BMJ’s education editors take you on a whistlestop tour through the BMJ’s education articles of 2019.

Tom Nolan (GP in London) is joined by Navjoyt Ladher (GP in London), Anita Jain (GP in India) and Jenny Rasanathan (GP in Phnom Penh).

Our reading list: Please don’t call me mum https://www.bmj.com/content/367/bmj.l5373

Which emollients are effective and acceptable for eczema in children? https://www.bmj.com/content/367/bmj.l5882

Pre-eclampsia: pathophysiology and clinical implications https://www.bmj.com/content/366/bmj.l2381

A borderline HbA1c result https://www.bmj.com/content/365/bmj.l1361

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)

This month:

(2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals.

(7.55) Carl has his pick of the top 100 altimetric most influential papers of the year.

(12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December.

(34.15) Helen has her annual rant about misogeny in medicine.

Reading list: Q fever—the superstition of avoiding the word “quiet” as a coping mechanism https://www.bmj.com/content/367/bmj.l6446

Altimetric Top 100 https://www.altmetric.com/top100/2019/

Fiona Godlee’s keynote at Preventing Overdiagnosis https://www.preventingoverdiagnosis.net/

Gender differences in how scientists present the importance of their research: observational study https://www.bmj.com/content/367/bmj.l6573

The internecine takes on medical specialty are a common thread in the Christmas BMJ, and this year we're doing it through the lens of driving. Which speciality speeds the most, who has the nicest cars?

André Zimerman, soon to be cardiologist, and researcher lets us know - and also why you can't rely on being a doctor to get off a speeding ticket. At least in Florida.

Read the full article: https://www.bmj.com/content/367/bmj.l6354

As editors, we feel like we’re spending a lot of time taking the superlatives out from articles - amazing, novel, important… But new research on BMJ.com suggests that we might not be doing that great a job, and that for some reason, papers authored by men tend to have more of them - because men put more in, or maybe a bias against woman writing in that way.

Marc Lerchenmueller, assistant professor at the University of Mannheim joins us to talk about how they did the research, and what it means for women's careers.

Read the full article https://www.bmj.com/content/367/bmj.l6573

We’re back for the December Talk Evidence, and this month we’re being very digital

Firstly,(1.20) Helen tells us about arthritic fingers - should we be using prednisolone for treatment when people have painful osteoarthritis of the hand

Then (13.30) Carl gets us all to check our fingers for clubbing, and we find out how useful it is as a test for lung cancer

(23.10) Minna Johansson GP and Cochrane Sweden researcher explains why EBM needs to take into account sustainability, and why that isn’t just carbon footprint.

(33.50) We talk AF and the Apple Watch - and why drop out is going to be a massive problem for the kind of big studies that they’re attempting to do with new consumer smart devices.

This month's reading: Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE) https://www.sciencedirect.com/science/article/pii/S0140673619324894?via%3Dihub

Cancer research UK - finger clubbing and mesothelioma https://www.cancerresearchuk.org/about-cancer/mesothelioma/symptoms/finger-clubbing

Cochrane launches new Sustainable Healthcare Field, in Lund https://sweden.cochrane.org/news/cochrane-launches-new-sustainable-healthcare-field-lund

Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa1901183

In this special edition of talk evidence, Helen Macdonald and Carl Henneghan talk about creating an evidence base from harms.

We hear from a member of the pubic who experienced harm from a drug, and now advises the FDA. A former regulator who explains why reporting harms is so important. And finally, an investigative journalist who explains what "ghost management" is.

The UK general election is happening this week, and you’ve probably made your mind up which MP you’re voting for already - and maybe the NHS has influenced that decision.

This year has seen an increase in the number of doctors running for parliament, and in this podcast we find out what motivates doctors to step away from clinical practice, and why their voice on national issues is important to guide the health of their patients.

We’re joined by Louise Irving, gp and former parliamentary candidate for the NHS action party, and Andy Cowper, editor of Health Policy Insight

UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.

We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.

This week we're focussing on what the NHS means to the election, from people who have been inside the political process and know about how campaign promises are made. We talk about retail pledges, and why spending claims which don't cause real change might come back to bite politicians.

Joining us are Sally Warren, director of policy at The King's Fund, Siva Anandaciva, chief analyst at The King's Fund and Bill Morgan, former policy advisor and founding partner of Incisive Health

www.kingsfund.org.uk/Podcast‎ https://www.kingsfund.org.uk/topics/general-election-2019

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.

We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.

This week we're focussing on health beyond the NHS - public health spending, and pledges to tackle air pollution and climate change. To discuss we're joined by Jennifer Dixon, chief executive of the Health Foundation, and Nicky Philpott, director of the UK Health Alliance on Climate Change.

Reading list The BMJ's 2019 election coverage https://www.bmj.com/content/general-election-2019

Health Foundation report: Mortality and life expectancy trends in the UK https://www.health.org.uk/publications/reports/mortality-and-life-expectancy-trends-in-the-uk

UK Health Alliance on Climate Change general election briefing http://www.ukhealthalliance.org/general-election-briefing/

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.

We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.

This week we're focussing on spending pledges. NHS budgets have not been keeping up with healthcare demand, and social care is in dire financial straits. David Oliver, consultant physician in Berkshire and author of the weekly BMJ “Acute perspective” column, and Hugh Alderwick, assistant director of policy at the Health Foundation.

Reading list Acute perspective column https://blogs.bmj.com/bmj/category/columnists/david-oliver/

Health Foundations analysis of spending https://www.health.org.uk/news-and-comment/blogsf

talk through what the parties are promising

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.

We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.

This week has seen pledges about GP numbers, so we're focussing on primary care - and are joined by two GPs, Clare Gerada, co chair of the NHS Assembly, and former chair of the Royal College of GPs, and Rebecca Rosen, who is also a senior fellow at the Nuffield Trust.

Reading list: Health, wellbeing, and care should be top of everyone’s political agenda https://www.bmj.com/content/367/bmj.l6503

Labour pledges to outspend Conservatives on health with £26bn NHS “rescue plan” https://www.bmj.com/content/367/bmj.l6537

Tories promise 6000 extra GPs by 2024 https://www.bmj.com/content/367/bmj.l6463

Is the number of GPs falling across the UK? https://www.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk

Reverse innovation may sound like some attempt to return to the dark ages - but it has a specific meaning, especially when it comes to med-tech. It’s about where we look for innovation - and overturning our preconceived ideas of where new ideas come from.

Mark Skopec, and Matthew Harris - both from Imperial College London are two of the authors of a new analysis, setting out to highlight those preconceptions, and creating new routes to bring innovation into the NHS.

Read the analysis: https://www.bmj.com/content/367/bmj.l6205

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor). This month Helen talks about the messy business of colon cancer screening - which modality is best, and in what population is it actually effective (1.40) Carl talks about how the Netherlands did the right research at the right time to stop a new pregnancy scan before it became routine (10.35) The Rant: acronyms in research papers (17.45) Mini Rant: politicisation of the NHS, and Carl pitches for yet another job (25.15) Research in the news has talked about the importance of when drugs are taken, to maximise efficacy. Melvin Lobo, cardiologist specialising in hypertension joins us to explain that research and why we seem to have forgotten about that effect.

Reading list: Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline https://www.bmj.com/content/367/bmj.l5515

Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial https://www.bmj.com/content/367/bmj.l5517

Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

Giving staff the confidence to speak out is important in healthcare - It's a key aspect of the WHO patient safety checklist, decreasing incidence of medical error, but it's also important to stop incidents of harassment and abuse which undermine staff and increase burnout.

Creating that culture is a difficult task, but two hospitals in the southern hemisphere have been trying to do do that by putting in place ways which support staff in making complaints when they wouldn't normally feel confident to do so.

In this podcast we hear from Alex Sia, CEO of KK hospital Singapore, Jeanette Conley, medical executive at Adventist Healthcare in Sydney and Mark O”Brien, medical director of the Cognitive Institute, who talk about their challenges and successes in changing the way they work.

For more on burnout; https://podcasts.apple.com/co/podcast/burnout-dont-try-to-make-canary-in-coal-mine-more-resilient/id283916558?i=1000446459269

http://www.bmj.com/wellbeing

The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world.

However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system.

Clare Gerada, GP and medical director of NHS PHP joins us to talk about how the expanded service will work, and what role regulation and inspections should play in wellbeing.

For more on the NHS PHP https://blogs.bmj.com/bmj/2019/10/31/clare-gerada-protecting-practitioners-health/ 020 3049 4505 https://php.nhs.uk/

There has been a lot of noise made about calorie counts on labels - the idea being it’s one of those things that might nudge people to make healthier choices.

So much so that in 2018, in the USA, it became mandatory for food chains with more than 20 outlets to label the calories in their food.

But the effectiveness of that is hard to gauge - it’s relied on reporting from customers, which leads to an incomplete picture. The really killer data would be from the chains themselves, but they’re reluctant to share that widely.

That's where new research comes in - and we're joined in the podcast by Joshua Petimar, postdoctoral researcher at the Harvard T.H. Chan School of Public Health, and Jason Block, associate professor at Harvard Pilgrim Healthcare Institute & Harvard Medical School, to discuss what they've done.

Read the full research: https://www.bmj.com/content/367/bmj.l5837

A TB infection can take two forms, active and latent. Active disease is transmissible, and causes the damage to the lungs which makes TB one of the biggest killers in the world.

In the latent form, the bacteria Mycobacterium tuberculosis is quiescent and can stay that way for years until it becomes active and causes those clinical signs.

Testing for the active version of the disease is done directly, but when it comes to latency, we use the tuberculin skin test to see if someone has an immunological response - and when that happens we consider them to have latent disease.

However, in this podcast Lalita Ramakrishnan, professor of immunology and infectious diseases at the University of Cambridge; Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania; and Marcel Behr, professor of medicine at McGill University question that conclusion.

Read their full analysis: https://www.bmj.com/content/367/bmj.l5770/

Their previous analysis: https://www.bmj.com/content/362/bmj.k2738.abstract

And search for their previous podcast - "Have we misunderstood TB's timeline?"

This week, Dr Arnav Agarwal joins Ray to share the perspective and experiences of a young, recently graduated doctor working in a busy, metropolitan hospital. Despite the long shifts and demanding environment, Arnav makes time and space to reflect on work, life and mortality through his thought-provoking poetry and volunteer work.

This week, Ray ventures into the notoriously complex field of nutrition with special guest, Professor Marion Nestle. Named by Forbes as one of the world's most powerful foodies, Marion’s stellar career spans five decades of research, teaching, advocacy work and the publication of countless prize-winning books.

Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world, but debate remains about their use for primary prevention for people without cardiovascular disease.

Paula Byrne from the National University of Ireland Galway, joins us to talk about the evidence of benefit for low risk individuals, and what needs to be done to finally answer the questions about efficacy and harms.

Read the full analysis: https://www.bmj.com/content/367/bmj.l5674

Direct-to-consumer genetic tests are sold online and in shops as a way to “find out what your DNA says".

They insights into ancestry or disease risks; others claim to provide information on personality, athletic ability, and child talent. However, interpretation of genetic data is complex and context dependent, and DTC genetic tests may produce false positive and false negative results.

Rachel Horton, clinical training fellow, Anneke Lucassen, chair of British Society of Genetic Medicine, and Jude Hayward the RCGP clinical champion for genomics join us to discuss how this deluge of genetic data is affecting patients, GPs and clinical geneticists in the NHS.

Read the full article: https://www.bmj.com/content/367/bmj.l5688

Blockchain is the digital technology that underpins cryptocurrencies such as bitcoin, and has been proposed as the digital panacea of our times.

But Leeza Osipenko, from the London School of Economics, has thought about how it could actually be used in clinical trials, and what else would need to change in our regulatory environment to make that work.

Read her full essay: https://www.bmj.com/content/367/bmj.l5561

In quality improvement, measurement is seen as a key driver of change - how well do you know you’re doing, if you can’t actually measure it.

So, when something changes in the NHS (say a new guideline) how can you tell how quickly that’s filtering down to the front line.

Ben goldacre, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, joins us to talk about a new proof of concept published on bmj.com, which uses NHS prescribing data to analyse how change propagated through GP practices.

Read the full open access research: https://www.bmj.com/content/367/bmj.l5205

https://openprescribing.net/

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor).

This month Carl talks about evidence that restricting your diet might improve health at a population level (1.50)

Helen talks about the data on a drop in alcohol consumption amongst Scots (7.04)

A listener questions the team about their take on Tramadol (13.45)

Helen talks about the problems with the trials we use to regulate drugs (18.00)

And Carl explains why drug shortages aren't just a Brexit problem (31.30)

Reading list:

two years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial https://www.sciencedirect.com/science/article/pii/S2213858719301512?via%3Dihub

Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18 https://www.bmj.com/content/366/bmj.l5274

Design characteristics, risk of bias, and reporting of randomised controlled trials supporting approvals of cancer drugs by European Medicines Agency, 2014-16: cross sectional analysis https://www.bmj.com/content/366/bmj.l5221

Crisis in the supply of medicines https://www.bmj.com/content/367/bmj.l5841

On the 1st of May, 2018 Scotland was the first country to try a new way of reducing alcohol consumption in its population. It introduced a minimum unit prices for alcohol.

Now new research just published on BMJ.com is looking at the effect of that price increase - and measuring how well it has achieved the goal of reducing drinking in Scots.

Peter Anderson, professor of alcohol studies at Newcastle University explains how well the result matched the expectation, and if the result targeted just lower earners, or all high volume drinkers.

Read the full research: https://www.bmj.com/content/366/bmj.l5274

The BMJ in partnership with The Harvard Global Health Institute has launched a collection of articles exploring how to achieve effective universal health coverage (UHC). The collection highlights the importance of quality in UHC, potential finance models, how best to incentivise stakeholders, and some of the barriers to true UHC.

One of those barriers, and it’s a big one, is climate change - patterns of disease will change, both communicable and non-communicable, cataclysmic weather will disrupt systems, and the economic impact is going to challenge our ability to pay for healthcare.

But even against that backdrop, Ashish Jha, and Rene Salas - aren't totally pessimistic. They join us to talk about the intersection between climate and health, and where effective change can be made.

Climate change threatens the achievement of effective universal healthcare https://www.bmj.com/content/366/bmj.l5302

Universal health coverage collection https://www.bmj.com/universal-health-coverage

Helen talks about new research on prevention of recurrent VTE - and Carl things the evidence goes further, and we can extend prophylaxis for a year.

13.00 - CRP testing for antibiotic prescription in COPD exacerbations, should we start doing it in primary care settings - and what will that mean. We also hear from Chris Butler, one of the trialists, who explains why being very clear about what you actually want to measure is important in study design.

26.50 - Carl wants you to read the Chief Medical Officer’s report, and we hear from Cathrine Falconer, who edited it, about how they put the recommendations together.

32.50 - Helen thinks that a new consultation from the UK government is collecting evidence in an unsystematic way, and that it’s an opportunity for listeners to submit some good evidence.

Reading list:

Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event https://www.bmj.com/content/366/bmj.l4363

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations https://www.nejm.org/doi/10.1056/NEJMoa1803185

Chief Medical Officer annual report 2019: partnering for progress https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2019-partnering-for-progress

Advancing our health: prevention in the 2020s – consultation document https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

Around half of trials that supported new cancer drug approvals in Europe between 2014 and 2016 were judged to be at high risk of bias, in a new study.

Huseyin Naci,assistant professor of health policy a the London School of Economics joins us to talk about why potential bias may mean potential exaggeration of treatment effects, and could be costing our health systems a great deal of money.

Read the full research: https://www.bmj.com/content/366/bmj.l5221

Listen on apple podcasts: https://podcasts.apple.com/gb/podcast/the-bmj-podcast/id283916558?mt=2&app=podcast

This week we saw the release of the much awaited Yellowhammer documents from the government, documents which outline some of the risks involved with Britain’s sudden departure from the EU. The documents themselves outline that there are risks to the supply of medicines - but do not set out the detail of how those risks have been mitigated, and what doctors and patients should do to plan for the possibility.

In this podcast we hear from Andrew Goddard , president of the Royal College of Physicians, and Sandra Gidley, president of the Royal Pharmaceutical Society. We also have a statement from the Royal College of Radiologists.

This week the Trump administration has banned the sale of flavoured vapes in the USA.

The reason for that is the sudden rash of cases of pulmonary disease, including deaths, linked to vaping. The mechanism by which vaping may be causing damage to the lungs is as yet unclear, and our understanding is hampered by the heterogeneous nature of the compounds involved and the mechanisms of delivery.

David Hammond, professor in the school of public health and health systems at the University of Waterloo in Canada, is author of a recent editorial about vaping and joins us to discuss what this means for public health.

Outbreak of pulmonary diseases linked to vaping https://www.bmj.com/content/366/bmj.l5445

In the UK, for just over a year, we've been paying the "Soft Drinks Industry Levy" - a tax on sugary beverages intended to reduce our consumption of free sugars.

That was based on taxes that had happened in other countries, however, in the UK high sugar snacks, such as confectionery, cakes, and biscuits make a greater contribution to intakes of free sugars as well as energy than sugar sweetened beverages.

Now new research models what extending the sugar tax to those snacks would do to our energy intake, and then onto the BMI of the nation.

Pauline Scheelbeek, assistant professor in nutritional and environmental epidemiology at the London School of Hygiene and Tropical Medicine joins us to explain how they modelled that, and what the outcome might be

Read the full open access research: https://www.bmj.com/content/366/bmj.l4786

Brexit.

Who knows what’s going to happen in the next few weeks, months, years - the uncertainty is high.

In the face of that, you’d hope that the government was doing all it could to plan for any eventuality - let alone for a massive, country altering one like suddenly crashing out without a deal - but Martin McKee, professor of public health at the London School of Hygiene and Tropical Medicine, and David Nicholl, Consultant Neurologist, don’t think that’s the case.

In the debate about Brexit, increasingly we’re hearing about the impact on health in the UK - and in increasingly doomed ways. But what about across the rest of Europe? Natasha Azzopardi Muscat, president of the European Public Health Association, explains a little about what Brexit means for the whole of European public health.

Assessing the health effects of a “no deal” Brexit: https://www.bmj.com/content/366/bmj.l5300

We heard a few podcasts ago about burnout - what it is, and why it should be thought of as a systems issue. Now a project in the Netherlands is trying to investigate who it is that is particularly at risk of burnout, and hopes to test whether individually tailored coaching and counselling can help those who are experiencing the symptoms change the way they’re working.

Karel Scheepstra is a psychiatrist and researcher in the Amsterdam University Medical Centre, and joins us to discuss what we know about burnout in Dutch doctors, and what this new research hopes to uncover.

For more from our wellbeing campaign; www.bmj.com/wellbeing

We know that exercise is good for you - the WHO recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic physical activity each week.

That recommendation is built on evidence that relied on self reporting that may underestimate the amount of lower intensity exercise those people were doing, and at the sometime overestimate the overall amount.

That makes new research, published on bmj.com particularly interesting - it pulls together the published data on outcomes for measured activity, where study participants were given an accelerometer to wear.

Ulf Ekelund, from the Department of Sports Medicine at the Norwegian School of Sport Sciences, joins us to discuss what they found, and what that means for those recommendations.

Read the open access research: https://www.bmj.com/content/366/bmj.l4570

Welcome back to Talk Evidence - where Helen Macdonald and Carl Heneghan take you through what's happening in the world of Evidence.

This month we'll be discussing tramadol being prescripted postoperatively, and a new EBM verdict says that should change(1.36). How much preventable harm does healthcare causes (11.20. A canadian project to help policy makers get the evidence they need (16.55)

One of our listeners thinks "Simple" GPs are anything but (28.30) - and we'll be asking Alexa about our health queries.

Reading list

Treating postoperative pain? Avoid tramadol, long-acting opioid analgesics and long-term use https://ebm.bmj.com/content/early/2019/08/16/bmjebm-2019-111236

Prevalence, severity, and nature of preventable patient harm across medical care settings https://www.bmj.com/content/366/bmj.l4185

Helen Salisbury: “Alexa, can you do my job for me?” https://www.bmj.com/content/366/bmj.l4719

In 2001, Gottfried Hirnschall joined the WHO to work on the global response to HIV/AIDs, 18 years later he just retired as the director of WHO’s department for HIV and Hepatitis.

The intervening period, almost half the time we’ve been aware of the disease the fight against the infection has been characterised by scientific breakthroughs, and disappointments - but the people mobilised against the virus have changed the way the world funds global health, the way patients are included in research agendas, and saved lives.

Gottfried spoke to us during his post retirement holiday in France, and talked about his experiences, and what the legacy of HIV/AIDs will be.

Burnout is a problem in healthcare - it’s a problem for individuals, those who experience it and decide to leave a career they formerly loved, but it’s also a problem for our healthcare system. Burnout is associated with an increase in medical errors, and poor quality of care. Fundamentally it’s a patient safety issue.

But, unlike other patient safety issues we tend to think about it, and try to prevent it, at an individual not systems level.

However, Anthony Montgomery from the University of Macedonia, and Christina Maslach, from the University of California, Berkeley, urge us to start treating burnout as a systems issue. We hear about how we can spot burnout, and what can be done to try and mitigate it.

Read their full analysis Burnout in healthcare: the case for organisational change https://www.bmj.com/content/366/bmj.l4774

The UK has just seen it’s hottest July on record, including the highest ever temperature recorded. With climate change in the forefront of our minds, it’s timely that we have two editorials on the sustainability and health.

Michael Depledge, emeritus professor of environment and human health at University of Exeter Medical School, and author of the editorial Time and Tide, explains how closely the oceans and seas are linked to human health.

Also Gillian Leng, deputy chief executive and director of health and social care at NICE has ideas about what the NHS can do to become more sustainable, and how we could evaluate the impact treatments have on the planet.

Read the two editorials Time and tide - https://www.bmj.com/content/366/bmj.l4671 A more sustainable NHS - https://www.bmj.com/content/366/bmj.l4930

At EBM live recently, we ran a workshop with researchers, patients and clinicians to talk about patient rights in research - should patients be setting the full research agenda? Should they be full participants and authors?

Helen Macdonald, BMJ’s UK research editor and co-host of our talk evidence podcast sat down to Paul Wicks, researcher and patient, and Emma Cartwright, The BMJ's What your patient is thinking editor, to reflect on what the workshop uncovered - and where we should be moving to next.

Read more about the BMJ's patient and public partnership: https://www.bmj.com/campaign/patient-partnership

Go to EBM live in Toronto in 2020 https://ebmlive.org/ebmlive-2020/

Cannabinoid hyperemesis syndrome is a relatively newly recognised condition - but, according to one study, can account for up to 6% of patients presenting to emergency departments.

The causal mechanism is as yet unclear - but currently the only known way to prevent the syndrome is for the patient to stop their cannabis use.

Yaniv Chocron, chief resident at Lausanne University Hospital, Lausanne, Switzerland talks us through spotting the condition, and what we think might be the mechanism of action.

Read the full easily missed article: https://www.bmj.com/content/366/bmj.l4336

Cochrane Austria have been asking the public what they'd like to know about health. Not whether the latest drug is more efficacious, but whether glacier stone power cures hangovers.

Gerald Gartlehner, director of the Cochrane Austria Centre joins us to explain what they do, and how their evidence has been received.

Read more about the project (in German): https://www.medizin-transparent.at/

Fertility awareness based methods of contraception are increasingly being used for pregnancy prevention. In the US, the proportion of contraceptive users who choose such methods has grown from 1% in 2008 to approximately 3% in 2014.

Relative to other methods of pregnancy prevention, however, substantial misinformation exists around fertility awareness based methods of contraception, particularly about the effectiveness of specific methods and how to use them.

Rachel Urrutia, assistant professor of Obstetrics and Gynecology at the, University of North Carolina, and Chelsea Polis, senior research scientist at the Guttmacher Institute join us to describe the various fertility awareness based methods, and the evidence base behind all the options available.

Read the full clinical update https://www.bmj.com/content/366/bmj.l4245

This month we have some more feedback from our listeners (2.20)

Carl says it's time to start smoking cessation (or stop the reduction in funding for smoking reduction) (11.40) and marvels at how pretty Richard Doll's seminal smoking paper is.

It's gloves off for infection control (22.20)

Andrew George, a non-executive director of the Health Research Authority joins us to talk about their consultation on research transparency, and explains how you can get involved (27.04)

And we talk about a new tool for rating the transparency of pharma companies (37.40)

Reading list:

Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption https://www.bmj.com/content/365/bmj.l2287

Sixty seconds on . . . gloves off https://www.bmj.com/content/366/bmj.l4498

HRA transparency consultation https://www.hra.nhs.uk/about-us/consultations/make-it-public/our-vision-research-transparency/

Sharing of clinical trial data and results reporting practices among large pharmaceutical companies https://www.bmj.com/content/366/bmj.l4217

Margaret Heffernan has thought a lot about whistleblowing, and why companies don't respond well to it. She wrote the "Book Wilful Blindness: Why We Ignore the Obvious at our Peril".

In this podcast she talks about how culture, and groupthink, leads to a culture where whistleblowers are ignored, and why the NHS needs to change the way it treats people who try and call out poor care.

This was recorded at Risky Business - https://www.riskybusiness.events/ where you can find our more about the conference and watch previous talks.

It's been just over two years since a fire broke out in Grenfell tower, in west London, claiming the lives of 72 residents. 223 people survived, thanks to the work of the fire brigade and health care.

In this podcast we hear from Andrew Roe, assistant commissioner at London Fire Brigade, and Anu Mitra, consultant emergency physician at St Mary's hospital - they talk about the support which has been provided, and where more needs to be done to help frontline staff cope with the horrors of the job.

The interviews were recorded at Risky Business - https://www.riskybusiness.events/ - where you can find out more about the Risk in healthcare.

This week on the podcast, (2.02) a listener asks, when we suggest something to stop, should we suggest an alternative instead?

(8.24) Helen tells us to stop putting people on treatment for subclinical hypothyroidism, but what does that mean for people who are already receiving thyroxine?

(20.55) Carl has a black box warning about z drugs, and wonders what the alternative for sleep are.

(30.11) Finally the NEJM has published Jeff Drazen's dozen most influential papers - but not a systematic review amongst them. Cue the rant.

Reading list: Rapid rec on subclinical hypothyroidism https://www.bmj.com/content/365/bmj.l2006

Temporal trends in use of tests in UK primary care, 2000-15 https://www.bmj.com/content/363/bmj.k4666

Black box warning for z-drugs https://www.bmj.com/content/365/bmj.l2165

Drazen's dozen https://cdn.nejm.org/pdf/Drazens-Dozen.pdf

WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”.

But is it?

That’s what a to studies just published on bmj.com try and investigate - one of which pulls together all the data we have on smoking rates, from 1970 to 2015, and then a quasi-experimental study which tries to model what the effect of the FCTC has had.

Steven Hoffman, and Matthieu Poirier from the Global Strategy Lab at York University join us to explain what their research means, and why it’s time to double down on our attempts to reduce smoking.

Read the open access research: https://www.bmj.com/content/365/bmj.l2287 https://www.bmj.com/content/365/bmj.l2231

Nicole Stott is an engineer, aquanaut and one of the 220 astronauts to have lived and worked on the International Space Station.

In a confined space, under huge pressure, with no way out, it's important that teams maintain healthy dynamics, and individuals can manage their stress adequately, and in this podcast Nicole explains a little about living on the ISS and how she coped for 91 days.

Read more about the Space Art Foundation: https://www.bmj.com/content/365/bmj.l4244

More from Risky Business https://www.riskybusiness.events/

As Syria enters its ninth year of conflict, doctors are struggling to provide health care to a badly damaged country.

While dealing with medicine shortages, mass casualties and everything that comes with working in a warzone, healthcare facilities and their staff are also facing an unprecedented number of targeted and often repeated attacks.

According to a new report, there were 257 recorded attacks on hospitals, medical transportation and healthcare workers in Syria in 2018. And despite these attacks being illegal under international law, they are becoming the new normal.

In this podcast, Elisabeth Mahase talks to Feras Fares, a gynaecologist from Syria, Len Rubenstein, chair of the Safeguarding Health in Conflict Coalition, and Declan Barry, an Irish pediatrician who worked with MSF in Syria in 2013.

Hi impact, low probability events are a planners nightmare. You know that you need to think about them, but how can you prioritise which event - terrorist attack, natural disaster, disease outbreak, deserves attention - and how can you sell the risks of that, but not oversell them?

Risky business is a conference where some of these kind of things can be discussed - how do we think about risk, how do we plan for it - at this year’s conference we heard from one of the men who rescued the boys from a cave in Thailand, the fireman in charge of Grenfell, and the medical teams responding to the three latest terrorist attacks in the UK.

In this podcast we talk to Amy Pope, former advisor to the Whitehouse during president Obama’s tenure. There she was charged with thinking about these high impact, low probability events.

More from Risky Business https://www.riskybusiness.events/

It's What Matters To You day - #wmty - and in this podcast Anya de Iongh, The BMJ's patient editor, and Joe Fraser, author of Joe's Diabetes who works at NHS England on personalised care, get together to discuss what personalised care actually means, how it changes the ways in which patients and health professionals interact, and how it can be practically done.

We also hear from three people who are making personalised care actually happen

Jo McGoldrick is a health coach who works at Lions Health GP Practice in Dudley. Joanne Appleton is a Commissioning Manager for Personalised Care at Gloucester CCG Jono Broad lives with long term health conditions and is involved in regional and QI work around personalised care.

The NHS is about caring for people, free at the point of care, creating a safety net which catches the most vulnerable. Tech has been defined by the facebook maxim "move fast, break things" - looking to disrupt a sector, get investment and move on.

We want to be able to harness the potential utility of digital tech in the NHS - but how can those two cultures be reconciled, and what salutary lessons should we learn from other industries (pharmaceuticals, devices) before we embark on these new ventures.

In this podcast we hear from; Neil Sebire, Chief Research Information Officer and Director, Great Ormond Street Hospital Digital Research, Informatics and Virtual Environments (DRIVE) Unit Dr Ramani Moonesinghe, Professor and Head of Centre for Perioperative Medicine, University College London Indra Joshi, Digital Health and Artificial Intelligence Clinical Lead at the newly formed NHS X

We’ve been banging the drum about transparency of payment to doctors for years - we’ve even put a moratorium on financial conflicts of interest in the authors of any of our education articles. Not because we think that all doctors who receive money from industry are being influenced to push their agenda - but because we have no way of telling when that’s happening…

At the same time, and rightly, patient groups are becoming more involved in setting things like research priorities, and in guideline development - and we’re campaigning to increase that involvement. but as that involvement increases, it’s also important to make sure that potential industry influence is made transparent.

Piotr Ozieranski, is an assistant professor at the Department of Social and Policy Sciences at the University of Bath and one of the authors of a new analysis which attempts to build a picture of industry funding of UK patient groups.

Read the full analysis: https://www.bmj.com/content/365/bmj.l1806

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.

(1.05) Carl rants about bacon causing cancer

(7.10) Helen talks about prostate cancer, and we hear from the author of the research paper which won Research Paper Of The Year at the BMJ awards.

We also cover disease definition and a call to have GPs more involved in that process, (24.12)and a new call for papers into conflicts of interest (29.40)

Reading list: MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. https://www.ncbi.nlm.nih.gov/pubmed/29552975?dopt=Abstract

Reforming disease definitions: a new primary care led, people-centred approach https://ebm.bmj.com/content/early/2019/04/11/bmjebm-2018-111148

Commercial interests, transparency, and independence: a call for submissions https://www.bmj.com/content/365/bmj.l1706

Stroke mortality rates have been declining in almost every country, and that reduction could result from a decline in disease occurrence or a decline in case fatality, or both. Broadly - is that decline down to better treatment or better prevention.

Olena Seminog, a researcher, and and Mike Rayner, professor of population health, both from the Nuffield Department of Population Health at the University of Oxford, join us to discuss their study which has used a large database to try and determine what has most affected stroke mortality.

Read the full open access research paper: https://www.bmj.com/content/365/bmj.l1778

Looking after a young child is hard enough, but when that child has learning difficulties and displays challenging behaviour - the burden on parents can be extreme.

That behaviour may prompt a visit to the doctor, and in this podcast we’re talking about how parents can be supported in that - what services are available. We’ll also be discussing what is normal behaviour, and what might prompt a referral to a specialist team for further assessment.

In this podcast we're joined by 2 of the authors of a recent practice pointer - Managing challenging behaviour in children with possible learning disability. Angela Hassiotis - professor of psychiatry of intellectual disability at University College London and Michael Absoud - consultant in paediatric neurodisability at the Evelina London Children’s Hospital.

We also have Rebecca - mother of a child who displayed some of these behaviours, and is actually a parent/carer case worker supporting families of children with disabilities.

Read the full practice article: https://www.bmj.com/content/365/bmj.l1663

In the UK we have a complex relationship with gambling, the government licences the national lottery, and uses profit from that to fund our art and museum sector - horse racing is a national TV event, and we've seen a proliferation of betting shops on our high streets.

At the same time, there's increasing acceptance that gambling causes problems for some people - to the extent that it's been termed a "hidden epidemic" and a public health problem. And it's to that point that the authors of a new analysis have written in the BMJ - if we see gambling as a public health problem, why aren't we treating it as such.

To talk about that, we're joined in the studio by Heather Wardle - Wellcome humanities and social science research fellow at the LSHTM.

Read the full analysis: https://www.bmj.com/content/365/bmj.l1807

The National Surveys of Sexual Attitudes and Lifestyles is a deep look into the sex lives of us brits - and has been running now for 30 years, giving us some longitudinal data about the way in which those sex lives have changed. The latest paper to be published, based on that data, looks at the frequency of sex - how often different groups are having sex on a weekly basis, and has reported a drop in that frequency for some groups.

Joining us to talk about the research, and why we're having less sex, is Kaye Wellings, Professor of Sexual and Reproductive Health at the London School of Hygiene and Tropical Medicine.

Read the full open access research: https://www.bmj.com/content/365/bmj.l1525

Starting in the middle of April, the group “Extinction Rebellion” have organised a series of non-violent direct action protests. Most notably bringing central London to a standstill - but these events are now continuing around the country.

Predictably, they have received a lot of criticism - they have also received a lot of support - amongst those arrested at the protests have been a few doctors, despite reservations that some may have for the impact on their careers.

In this podcast, we'll hear from three people who have decided to support extinction rebellion, about why they do, and what the medical community's support might mean for climate change.

We're joined by Rowan Williams, Master of Magdalene College, Cambridge and former Archbishop of Canterbury - the principle leader of the church of England. Robin Stott, retired physician and campaigner, and Alex Armitage, paediatric trainee.

Schoolchildren’s activism is a lesson for health professionals https://www.bmj.com/content/365/bmj.l1938

Just 11 years to avert disaster https://www.bmj.com/content/365/bmj.l1801

Here's a taster for our new student podcast - Sharp Scratch. We're talking about the hidden curriculum, things you need to know to function as a doctor, but are rarely formally taught.

This is a taster - if you enjoy, subscribe! https://podcasts.apple.com/gb/podcast/student-bmj-podcast/id331561304

Sharp Scratch episode 1: Surviving the night shift.

Why nights shifts mess with your brain, how astronauts will cope with the time difference on Mars, and the power of frozen grapes when you need a boost.

Join medical students Laura, Ryhan, Declan, and newly qualified doctor Chidera as we figure out how to survive the night shift. Featuring a guest interview with NASA researcher Erin, leader of the Fatigue Countermeasures Group.

https://www.bmj.com/sharpscratch

In the UK, there's an ethnic group that is surprisingly large, but often overlooked by society, and formal healthcare services. The gypsy traveller community have poorer health outcomes because of systemic issues around access to health and education.

In this podcast we're joined by Michelle Gavin and Samson Rattigan, who both work for Friend's Families and Travellers - and who have have been working hard in East Sussex to bridge the gap between the healthcare system and those who identify as gypsies or travellers, and explain some of the simple ways in which GPs and hospitals can support this neglected group.

https://www.gypsy-traveller.org/

An “author pays” publishing model is the only fair way to make biomedical research findings accessible to all, say David Sanders, professor of gastroenterology at Sheffield University, but James Ashton and worries that it can lead to bias in the evidence base towards commercially driven results - as those are the researchers who can pay for open access fees. Dave deBronkart just wants patients to have access to key research.

Read the full head to head: https://www.bmj.com/content/365/bmj.l1544

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.

(1.20) Carl grinds his gears over general health checks, with an update in the Cochrane Library.

(9.15) Helen is surprised by new research which looks at over prescription of antibiotics - but this time because the courses prescribed are far longer than guidelines suggest.

(22.30) What is the true 99th centile of high sensitivity cardiac troponin in hospital patients?

(29.02) Is it time to abandon statistical significance and be aware of the problem of the transposed conditional.

Reading list: General health checks in adults for reducing morbidity and mortality from disease - https://www.ncbi.nlm.nih.gov/pubmed/30699470?dopt=Abstract

Duration of antibiotic treatment for common infections in English primary care -https://www.bmj.com/content/364/bmj.l440

True 99th centile of high sensitivity cardiac troponin for hospital patients - https://www.bmj.com/content/364/bmj.l440

Significant debate - https://www.nature.com/magazine-assets/d41586-019-00874-8/d41586-019-00874-8.pdf

The false positive risk: a proposal concerning what to do about p-values - https://www.youtube.com/watch?v=jZWgijUnIxI http://www.onemol.org.uk/?page_id=456

On the 7th of June, 1753, Dr Archibald Cameron was executed at Tyburn. "The body, after hanging twenty minutes, was cut down: it was not quartered; but the heart was taken out and burnt. "

250 years later, his sixth great grandson, Robert Syned found himself deeply involved in the process of execution, as an expert witness in a case about the use of a new drug for lethal injection in the USA.

In this podcast, Robert joins us to talk about the dearth of evidence, and massive variation in the use of drugs used to execute someone, and reflects on how finding out about his ancestor meant to him in this process.

Jessica Perlo is the Director for Joy at Work at the Institute for Healthcare Improverment, and James Mountford is direct or of quality at the Royal Free London NHS Foundation Trust.

Together they joined us at the International Forum on Quality and Safety in Healthcare to discuss joy at work - what that concept actually means, and practically, how hospitals can start implementing it.

Watch Jessica’s session at the forum https://internationalforum.bmj.com/glasgow/2018/09/20/a1-leadership-models-for-co-producing-a-joyful-workforce/

BMJ's wellbeing campaign https://www.bmj.com/wellbeing https://www.facebook.com/groups/569230966796440/

Non-medical interventions are increasingly being proposed to address wider determinants of health and to help patients improve health behaviours and better manage their conditions - this is known as social prescribing. In England, the NHS Long Term Plan states that nearly one million people will qualify for referral to social prescribing schemes by 2024.

In this podcast, Chris Drinkwater, emeritus professor of primary care and Louise Cook, a link worker, both at Newcastle University's Ways to Wellness - who provide social prescribing support.

They describe the evidence base for the service, how they work with patients to coordinate their non-medical interventions, and how they measure success.

Read the full clinical update: https://www.bmj.com/content/364/bmj.l1285

Change requires the application of power - the way in which individuals can accrue power has shifted in our digitally connected world. Traditional ways of influencing change in healthcare (getting the chief executive on side, having a quiet chat with the medical director) are not the only way to build a momentum.

Henry Timms - author of “New Power” the internationally best selling book joins us to talk about about how much of his thinking on these power structures has come from healthcare.

https://thisisnewpower.com/ https://twitter.com/hashtag/newpower Henry Timms onstage at the International Forum on Quality and Safety in Healthcare https://livestream.com/IFQSH/Glasgow2019/videos/189271449

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.

They start by talking about shoulders - what does the evidence say about treating subacromial pain, and why the potential for a subgroup effect shouldn't change our views about stop surgery (for now, more research needed).

(16.00) Statins - more uncertainty about statins, this is now looking at older people. Age is a big risk factor for cardiovascular disease - at what point does that risk overwhelm any potential benefit from taking statins?

(20.30)Carl explains his rule-of-thumb for turning relative risks into absolute risks, in a way can help doctors talk to patients about new evidence.

(25.46)What's the evidence for doctors messes? Carl's rant of the week focuses on the calls (including the BMJ's campaign) to have spaces for doctors to relax in hospitals. He asks, is that better than putting in a gym? What's the evidence for that.

Reading list: Subacromial decompression surgery for adults with shoulder pain https://www.bmj.com/content/364/bmj.l294

Efficacy and safety of statin therapy in older people https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext

The future of doctor's messes https://www.bmj.com/content/364/bmj.k5367.abstract

As England’s presumed consent law for 2020 clears parliament, Veronica English, head of medical ethics and human rights at the BMA, say that evidence from Wales and other countries shows that it could increase transplantation rates. But Blair L Sadler, physician and senior adviser to California State University, consider such legal changes a distraction lacking strong evidence: they say that public education and trained staff would have a proven impact.

We also hear from Erin Walker, the recipient of 2 liver transplants, about her concerns on families over-ruling donor's wishes.

Read the full debate, and Erin's commentary: https://www.bmj.com/content/364/bmj.l967

It can be difficult to know what to do when a person in severe psychological distress presents to a general practice or community clinic, particularly if they are behaving aggressively, or if they are refusing help.

Most patients who are acutely disturbed present no danger to others, however situations can evolve rapidly. Frontline staff need to know how to call for help, how to assess and manage physical risk, and how to de-escalate such situations.

In this podcast Aileen O’Brien, reader in psychiatry and education at St George’s University of London joins us to give some advice on what to do in that situation - why deescalation is useful, and who else to involve.

We also hear from someone who lives with bipolar disorder, and has had experiences of being acutely unwell in a public places, which have lead to police and psychiatric intervention.

Read the full practice article: https://www.bmj.com/content/364/bmj.l578

In every generation there are a few that know the secret; the counterintuitive effects of loop diuretics.

In this podcast Steven Anisman, cardiologist at the Dartmouth Hitchcock Department of Cardiovascular Medicine, joins us to explain about the threshold effects of these drugs, and why that might change the way in which you think about prescribing them.

Read the full article on treatment of oedema with loop diuretics, and contribute to the discussion: https://www.bmj.com/content/364/bmj.l359

Renza Scibilia and Chris Aldred have diabetes, and their introduction to the idea of complications arising from the condition were terrifying.

Because of this early experience, and Chris's later development of complications, they have campaigned to make doctors really think about the way in which they talk about complications with patients. Challenging the use of "non-compliant" and other stigmatising language.

Chris has also documented his experience of developing an ulcer, and having it successfully treated, on social media, to open up the conversation and make us all #talkaboutcomplications.

Chris Aldred is @grumpy_pumper on twitter, and blogs at http://www.the-grumpy-pumper.com. Renza Scibilia is @RenzaS on twitter and blogs at https://diabetogenic.wordpress.com/

In 2014, Oliver Johnson was a 28 year old British doctor, working on health policy in Sierre Leone after finishing medical school. Also working in Freetown was Sinead Walsh, then the Irish Ambassador to the country.

Then the biggest outbreak of Ebola on record happened in West Africa, starting in Guinea and quickly spreading to Liberia, Sierre Leone and Nigeria.

Oliver and Sinead have co-authored a book about the change that wrought on their lives, how they stepped into roles coordinating the international response to the disease and running a treatment centre. They join us today to talk about their experiences there.

For more information about Ebola, including the current outbreak in the Democratic Republic of Congo visit https://www.bmj.com/ebola.

For Sinead and Oliver's book - Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline is available now.

https://www.amazon.co.uk/dp/B07DFLFF9P/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

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If you've been keeping up to day with The BMJ - online on in print, you might have noticed that we've got a new type of article - NIHR Signals - and they are here to give busy clinicians a quick overview of practice changing research that has come out of the UK's National Institute for Health Research.

Tara Lamont, director of the NIHR dissemination centre, joins us to talk a bit more about the research underpinning these articles.

You can find the full list of articles: https://www.bmj.com/NIHR-signals

More doctors are choosing to retire early, doctors who take career breaks find it hard to return to practice, and doctors at all stages of their careers are frustrated by the lack of support given to training and development in today’s NHS.

Each year the BMJ holds a roundtable discussion at the Nuffield Summit - where health leaders come together to talk about the NHS. We wanted to know what more the NHS can do to provide fulfilling careers for staff and to improve support for doctors who want to keep working and those seeking to return to practice.

Taking part in the discussion were:

Tom Moberly - UK editor for The BMJ Rahkee Shah - paediatric registrar Ronny Cheung - consultant general paedatrician Claire Lemer - consultant paediatrician Candace Imison - Director of Workforce Strategy at the Nuffield Trust James Morrow - GP partner

Diabetes is synonymous with sugar, but diabetes insipidus, "water diabetes", can't be forgotten. Between 2009 and 2016, 4 people died in hospital in England, when lifesaving treatment for the condition was not given.

In this podcast, we hear some practical tips for non-specialists to aid diagnosis, and how patients should be managed during hospital admission.

On the podcast are Miles Levy, consultant endocrinologist from Leicester Royal Infirmary Pat McBride, head of family services at the Pituitary Foundation John Wass, professor of endocrinology at Oxford University Malcolm Prentice, consultant endocrinologist at Croydon University Hospital.

Read the full practice article: https://www.bmj.com/content/364/bmj.l321

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.

They start by talking about how difficult a task it is to find evidence that's definitely practice changing, what GPs can learn from Malawian children with nonsevere fast-breathing pneumonia, how radiation dosage varies substantially - and consultant radiologist Amy Davies what that means for patients.

They also rail against add-on tests for fertility, and the lack of evidence underpinning their use - will the traffic light system suggested help patients make treatment choices.

Carl's rant this week is based on a new study by Steve Woloshin and Lisa Schwartz which documented 20 years of medical marketing in the USA.

Reading list: Pneumonia in Malawi - https://www.ncbi.nlm.nih.gov/pubmed/30419120 Variation in radiation dose - https://www.bmj.com/content/364/bmj.k4931 Traffic light fertility tests - https://www.bmj.com/content/364/bmj.l226 Medical marketing - https://jamanetwork.com/journals/jama/fullarticle/2720029

The problem we had publishing our feed has been fixed, and normal service has resumed.

Thank you for subscribing to the podcast, if you have thoughts you'd like to express, we'd love to hear them.

https://www.bmj.com/podcasts

Recent years have seen political and social progress for people who identify as LGBT+ (lesbian, gay, bisexual, and transgender; the “+” indicating inclusion of other minority sexual and gender identities).

Yet international evidence shows ongoing health and social inequalities in this group, many of which emerge during adolescence and represent unique safeguarding risks.

In this podcast, Kate Addlington, psychiatry trainee and associate editor at The BMJ is joined by Ginger Drage, expert patient educator at University College London, Jessica Salkind, academic clinical fellow in paediatrics & teaching lead for LGBT+, at Imperial College London and Rosanna Bevan, psychiatry trainee from East London Foundation Trust

They discuss the the risks faced by LGBT+ young people, which include increased rates of self harm, suicide, and family rejection or abuse, and what steps clinicians can take to support and intervene if necessary.

Read the full practice article: https://www.bmj.com/content/364/bmj.l245

Current evidence is sufficient to justify a national screening programme, argues Mark Lown clinical lecturer at the University of Southampton, but Patrick Moran, senior research fellow in health economics at Trinity College Dublin, thinks there are too many unanswered questions and evidence from randomised trials is needed to avoid overdiagnosis

Read the full debate: https://www.bmj.com/content/364/bmj.l43

Patients who experience chronic rhinosinusitis may way for a considerable period of time before presenting, because they believe the condition to be trivial.

In this podcast, Alam Hannan, ENT Consultant at the Royal Throat Nose and Ear Hospital in London, explains why that belief is not founded, and describes which treatments can be effective at providing relief.

The Royal College of Physicians will survey all its members in February on this most controversial question. It says that it will move from opposition to neutrality on assisted dying unless 60% vote otherwise.

The BMJ explores several conflicting views. From Canada, palliative care doctor Sandy Buchman explains why he sees medical aid in dying as a compassionate treatment that fully respects patient autonomy. The Canadian Medical Association is neutral on the issue, and Jeff Blackmer, its vice president for international health, shares how that stance enabled it to represent all its members, including doctors with conscientious objections.

But many are unconvinced to say the least. Rob George, a UK palliative care doctor and professor at King's College London, says assisted suicide has no place in medicine. Tony Baldwinson, from the UK campaign group Not Dead Yet, worries for disabled people were society to endorse doctors actively ending lives. And Zoe Fritz, a consultant physician in acute medicine at Addenbrooke’s Hospital, Cambridge, has a proposal that she says would protect the doctor-patient relationship.

Read all our content at https://www.bmj.com/assisted-dying

"Why I decided to provide assisted dying: it is truly patient centred care" by Sandy Buchman https://www.bmj.com/content/364/bmj.l412 "How the Canadian Medical Association found a third way to support all its members on assisted dying" by Jeff Blackmer https://www.bmj.com/content/364/bmj.l415 "Religious and non-religious people share objections to assisted suicide" by Mark Pickering https://blogs.bmj.com/bmj/2019/01/30/religious-and-non-religious-people-share-objections-to-assisted-suicide/ "The courts should judge applications for assisted suicide, sparing the doctor-patient relationship" by Zoe Fritz https://blogs.bmj.com/bmj/2019/01/30/the-courts-should-judge-applications-for-assisted-suicide-sparing-the-doctor-patient-relationship/

We have had two articles published recently on bmj.com, looking at drug prevention of HIV; PeP - Post-exposure Prophylaxis and PreP - Pre-exposure Prophylaxis, neither prevent the virus from entering the body, but they do prevent the infection from taking hold.

There are lots of questions that doctors have about these - what are the risk profiles of patients who should be offered the treatments? How can they be prescribed? What are the side effects? And if you're in England, where PreP is not yet available on the NHS, can doctors advise their patients to buy it online?

Michael Brady, Sexual health and HIV consultant at Kings College Hospital and Medical Director of the Terrence Higgins Trust, joins us to help answer those questions.

Further reading BMJ article on PeP https://www.bmj.com/content/363/bmj.k4928 BMJ article on PreP BASHH guidelines on PreP - https://www.bashhguidelines.org/media/1189/prep-2018.pdf https://iwantprepnow.co.uk http://www.aidsmap.com/

Jönköping has been at the centre of the healthcare quality improvement movement for years - but how did a forested region of Sweden, situated between it's main cities, come to embrace the philosophy of improvement so fervently? Goran Henriks, chief executive of learning and innovation at Qulturum in Jönköping joins us to explain. He also tells us about Esther, and why she figures so centrally in their planning.

In this EBM round-up, Carl Heneghan, Helen Macdonald and Duncan Jarvies are back to give you an update

Dual vs single therapy for prevention of TIA or minor stroke - how does the advice that dual work better translate in the UK?

Carl explains why Japan can teach us to get active and, how GPs can use that information to "drop a decade" in aging.

Finally, Helen took some time to relax over Christmas - until she read a story in the Christmas edition about gender discrimination in medicine, and it reminded her of her time on the ward.

Reading list:

The BMJ Practice: Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke https://www.bmj.com/content/363/bmj.k4169

Delaying and reversing frailty: a systematic review of primary care interventions https://bjgp.org/content/early/2018/11/30/bjgp18X700241

Terence Stephenson is a consultant paediatrician who became been chair of the General Medical Council in 2015.

His 4 year tenure has now come to an end, but during his time with the regulator the medical profession faced a number of challenges - the case of Hadiza Bawa Garba and a growing recruitment crisis in the NHS - the GMC is the gatekeeper for foreign doctors who who wish to work here. As the rules on EU doctors change, the GMC’s regulatory practice may have to change too.

In this podcast, Abi Rimmer, a report and editor for The BMJ, went to Terrence’s office to talk to him about his career at the GMC, and his perspective on how the organisation has responded to those challenges.

Read the related article: https://www.bmj.com/content/363/bmj.k5402

Susan Greenhalg is a research professor of chinese society in Harvard’s department of anthropology - not a natural fit for a medical journal you may think, but recently she has been looking at the influence of Coca Cola on obesity policy in China.

She has written up her investigation in an article published on bmj.com this week, and joins us in the podcast to talk about why a communist country would embrace a message from an icon of capitalism, and what attitudes toward financial conflicts of interest exist in the country.

Read the full feature: https://www.bmj.com/content/364/bmj.k5050

Accompanying editorial: https://www.bmj.com/content/364/bmj.l4

For many of you Christmas is over and, you’re back to work. Admin piled up over christmas? Feeling resentful for all those forms, and the weird codes they make you put in them?

In this podcast I hope we can explain why that’s important, with 17th century death, the esoteria of reed codes, and why the WHO cares about spaceship accidents.

Consumption, flux, and dropsy: counting deaths in 17th century London https://www.bmj.com/content/363/bmj.k5014

Christmas guide to clinical coding https://www.bmj.com/content/363/bmj.k5209

2018 will go down in history as a year of reckoning as the year that that some men’s behaviour came back to bite them. The continuing impact of #MeToo across the world has prompted another round of thinking about women’s experiences in medicine, which can be seen this year’s christmas journal

In this podcast, Esther Choo and Eleni Lenos, join us to discuss their research into mother's experiences of being doctors - and how discrimination is still rife against them.

Also Sarah Lowry, from the Royal College of Physicians brings us some other women's voices - this time from the RCP exhibition "This vexed Question: 500 years of women in medicine"

Visit the exhibition: https://www.rcplondon.ac.uk/events/vexed-question-500-years-women-medicine

Physician mothers’ experience of workplace discrimination: a qualitative analysis https://www.bmj.com/content/363/bmj.k4926

A lexicon for gender bias in academia and medicine https://www.bmj.com/content/363/bmj.k5218

the Christmas BMJ season is upon us - if you’re to go to our website now, you’ll see that it’s been a bumper year. In the podcast, we’re going to be bringing you a select few - we’ll be looking at motherhood. Trying to figure out what 17th Century causes of death were, and - as it’s christmas - in this pod we’ll be looking at food.

We talk to Frances Mason and Amanda Farley, from the University of Birmingham, about their RCT examining the “Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period" https://www.bmj.com/content/363/bmj.k4867

We also have Eric Robinson from the University of Liverpool explains how calorific restaurant food from his observational study, "(Over)eating out at major UK restaurant chains" https://www.bmj.com/content/363/bmj.k4982

In the second of our EBM round-ups, Carl Heneghan, Helen Macdonald and Duncan Jarvies are joined by Deborah Cohen, investigative journalist and scourge of device manufacturers.

We're giving our verdict on the sensitivity and specificity of ketone testing for hyperemesis, and the advice to drinking more water to prevent recurrent UTIs in women.

Deb joins us to talk about the massive, international, investigation into failing regulation for implantable devices - and shares some of the stories where these have harmed patients.

Finally, Carl is excised about antivaxer ads on facebook - but Helen has seen some pro-vaccine ones which are poor science too.

Reading list:

Diagnostic markers for hyperemesis gravidarum https://www.ncbi.nlm.nih.gov/pubmed/24530975

Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705079

The great implant scandle https://www.bbc.co.uk/iplayer/episode/b0btjr55/panorama-the-great-implant-scandal

Facebook antivaccine ads https://www.independent.co.uk/news/uk/home-news/anti-vaccination-antivaxxers-uk-advert-banned-facebook-post-vaccines-kill-babies-a8620831.html

A new collection of articles published by The BMJ includes twelve country case studies, each an evaluation of multisectoral collaboration in action at scale on women’s, children’s, and adolescent’s health.

Collectively these twelve studies inform an overarching synthesis and accompanying commentaries, drawing together lessons learned in achieving effective multisectoral collaboration.

In this podcast, Wendy Graham, professor of obstetric epidemiology at the London School of Hygiene and Tropical Medicine, and Shyama Kuruvilla, senior strategic advisor to the World Health Organisation, join us to discuss what can be learned from those case studies.

Read all the case studies: https://www.bmj.com/multisectoral-collaboration

Infant formula manufacturers were made pariah in the 70s, because of their marketing practices - this lead to “The Code”, adopted by the WHO, which set out clear guidelines about what those practices should be.

Now an investigation on bmj.com by Chris Van Tulleken, honorary senior lecturer at University College London, examines the practices associated with the marketing of specialist milk formula for children with cow’s milk protein allergy, and asks whether doctors organisations should be receiving money from that industry.

Read the full investigation: https://www.bmj.com/content/363/bmj.k5056

Nausea and vomiting in pregnancy affects around 70% of pregnancies. It is mild for around 40% of women, moderate for 46%, and severe for 14%.

By contrast, hyperemesis gravidarum is a complication of pregnancy rather than a normal part of it and occurs in around 1.5% of pregnancies. The psychosocial burden of HG can be heavy for women and their families.

In this podcast, Caitlin Dean Phd Candidate, Gillian Ostrowski, general practitioner, Rebecca C Painter, consultant obstetrician join us to explain what hyperemesis is like for those who experience it, and discuss what treatment options are available.

Read the full article: https://www.bmj.com/content/363/bmj.k5000

Healthy self confidence has an important role in surgery, but what came first - the surgeon or the ego?

In this conversation, Christopher Myers, Yemeng Lu-Myers, and Amir Ghaferi join us to talk about the (very few) surgeons who behave badly in theatre, and why that behaviour has persisted, and can be detrimental.

Read their full analysis: https://www.bmj.com/content/363/bmj.k4537

Until recently, The BMJ had a campaign of patient partnership - now we have a patient and public partnership campaign. The reason for that change is that medicine has an effect beyond the individual being treated - and this podcast interview is a very good example of that.

Anya De Iong, patient editor for The BMJ, talks to Christine Morgan - independent chair of the Greater Manchester Carers Strategic Group. Christine has a mission to bring the needs of carers into thinking and planning about the NHS - and explains how the needs of patients and carers may be similar, and different.

You’ll have read in a clinical trial “Most patients had an acceptable adverse-event profile.” Or that a drug “has a manageable and mostly reversible safety profile.” And that “the tolerability was good overall.”

In this podcast, Bishal Gyawali (@oncology_bg) joins us to describe what events those terms were actually describing in cancer drug trials, and how they reduce the readers appreciation of the adverse effects of these novel drugs.

Read the full analysis: https://www.bmj.com/content/363/bmj.k4383

Welcome to this, trial run, of a new kind of BMJ podcast - here we’re going to be focusing on all things EBM.

Duncan Jarvies, Helen Macdonald and Carl Heneghan - and occasional guests- will be back every month to discuss what's been happening in the world of evidence.

We'll bring you our Verdict on what you should start or stop doing, geek out about stats, and rant about the unevidence based world in which we live.

This week we talk about:

Vitamin D https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30265-1/fulltext

Oxygen https://www.bmj.com/content/363/bmj.k4169

The UK parliament's report on clinical trial transparency https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/1480/1480.pdf

Machines that can learn and correct themselves already perform better than doctors at some tasks, but not all medicine is task based - but will AI doctors ever be able to have a therapeutic relationship with their patients?

In this debate, Jörg Goldhahn, deputy head of the Institute for Translational Medicine at ETH Zurich thinks that the future belongs to robot doctors - but Vanessa Rampton, Branco Weiss fellow at McGill Institute for Health and Social Policy, says they'll never be able to emulate the empathy required.

We're also joined by Michael Mittelman, executive director of the American Living Organ Donor Fund, who has had complex healthcare needs for his whole life - to explain what he feels about the prospect of his care delivered by machine.

Read the full debate:

https://www.bmj.com/content/363/bmj.k4669

Clinical trials for regulatory approval are designed to test efficacy, but new drugs might have adverse reactions - reactions those trials aren’t designed to spot.

To talk about those adverse reactions - how to spot them, how to report them and what to do about them, we're joined by Robin Ferner, from the West Midlands Centre for Adverse Drug Reactions.

Read the full practice article: https://www.bmj.com/content/363/bmj.k4051

As the accompanying editorial to this article says, "oxygen has long been a friend of the medical profession Even old friendships require reappraisal in the light of new information."

And that’s what a new rapid reccomendation - Oxygen therapy for acutely ill medical patients - does.

To discuss we're joined by two of the authors, Reed Simieniuk, general internist at McMaster University and Gordon Guyatt, distinguished professor at McMaster University.

Read the full recommendation: https://www.bmj.com/content/363/bmj.k4169

Cardiovascular factors are associated with risk of stroke - and those factors can be mediated by lifestyle and by genetic make up.

New research published by The BMJ sets out to explore how these risks combine, and we're joined on the podcast by two of the authors - Loes Rutten-Jacobs, senior postdoctoral researcher at the German Center for Neurodegenerative diseases, and Susanna Larsson, associate professor at the Karolinska Institutet.

Read the full open access research: https://www.bmj.com/content/363/bmj.k4168

On the podcast, we’ve talked a lot about the limits of medicine - where treatment doesn’t work, or potentially harms. But in that conversation, we’ve mainly focused on specific treatments.

Now a new analysis, broadens that to talk about patients being admitted to a whole ward - intensive care. The authors of that article contend that, often, patients or their families don’t fully understand the implication of that admission.

To discuss, we're joined by Jamie Gross, consultant in intensive care medicine at London North West University Healthcare NHS Trust, and by Barry Williams, patient representative at the Intensive Care Society.

Read the full analysis: https://www.bmj.com/content/363/bmj.k4135

The common cold is usually mild and self limiting - but they’re very annoying, especially the runny nose and bunged up feeling that form the nasal symptoms.

A new practice article, published on BMJ.com looks at the available evidence for treatment of those nasal symptoms - both pharmacological and alternative.

In this podcast we're joined by Mieke van Driel - GP in Australia and a professor of primary care at The University of Queensland, and An De Sutter - GP in Belgium and professor of family medicine at Ghent University.

Read the full article, and play with the interactive infographic: https://www.bmj.com/content/363/bmj.k3786

What can we learn from the shameful story of vaginal mesh? That thousands of women have been irreversibly harmed; that implants were approved on the flimsiest of evidence; that surgeons weren’t adequately trained and patients weren’t properly informed; that the dash for mesh, fuelled by its manufacturers, stopped the development of alternatives; that surgeons failed to set up mesh registries that would have identified complications sooner; and that the National Institute for Health and Clinical Excellence and the UK regulators let them off the hook.

The BMJ has a published an investigation into vaginal mesh, which charts some of the issues above.

In this podcast The BMJ talked to three women who have had a vaginal mesh implanted, and all suffered the negative consequences that have prompted these investigations.

We bring you these stories to underline how life altering the situation has been for these woman, and to highlight the need for fully informed consent before anyone else has a mesh implanted.

What we must learn from mesh: https://www.bmj.com/content/363/bmj.k4254

There is very little guidance on withdrawing or tapering opioids in chronic pain (not caused by cancer). People can fear pain, withdrawal symptoms, a lack of social and healthcare support, and they may also distrust non-opioid methods of pain management.

This can mean that patients receive repeat opioid prescriptions for extended periods of time.

In this podcast, Harbinder Sandhu, health psychologist in pain management at Warwick Medical School, Andrea Furlan, associate professor of medicine at University of Toronto, and Sam Eldabe, consultant in pain medicine at The James Cook University Hospital join us to set out the evidence on tapering opioids - and give practical advice on how to support patients. We're also joined by Colin, who was prescribed opioids for a decade, before he decided to reduce his usage.

What you need to know:

For people with chronic pain and who do not have cancer, the benefits of long term opioids are outweighed by the issues of tolerance, dependence, and the requirement for higher doses

Tapering is the gradual reduction of opioids with the aim of limiting withdrawal symptoms; it may target complete discontinuation of the opioid, or on occasion a reduction of the dose

It is not clear how best to support people to taper their opioids; whether it is best done by interdisciplinary pain management programmes, buprenorphine substitution, or behavioural interventions

Read the full uncertainties paper: https://www.bmj.com/content/362/bmj.k2990

Ted Kaptchuk, professor of medicine at Harvard Medical school - and leading placebo researcher, has just published an analysis on bmj.com describing the effect of open label placebo - placebos that patient's know are placebos, but still seem to have some clinical effect.

Ted joins us to speculate about what's going on in the body, what this means for designing a more effective placebo, and asking whether it's time to start honestly prescribing placebos in the clinic.

Read his full analysis: https://www.bmj.com/content/363/bmj.k3889

We want clinical trials to be thorough - but Vinay Prasad, assistant professor of medicine at Oregon Health Science University, argues that the problem of overdiagnosis may be as prevalent, in the way we measure disease in our research, as our practice.

In this podcast he joins us to discuss the problem, and why he thinks what qualifies as disease in clinical trials may be getting so broad that outcomes are becoming less meaningful and harder to interpret.

Read the full analysis: https://www.bmj.com/content/362/bmj.k3783

Brits have a reputation as Europe’s boozers - and for good reason, with alcohol consumption higher than much of the rest of the continent. That reputation is extended to our young people too - but is it still deserved? Joanna Inchley, senior research fellow at the University of St Andrews, explains new research on decreasing drinking - http://www.hbsc.org/

Also this week, as part of our coverage of the 70th anniversary of the founding of the NHS, we’ve been running a series of articles exploring this unique institution’s future. Neena Modi, professor of neonatal health, and Jonathan Clarke, clinical research fellow, from Imperial College London, passionately believe that the NHS needs to be publicly financed - and importantly, publicly provided.

https://www.bmj.com/content/362/bmj.k3580

Last week we heard about how evidence in policy making is imperilled - but today we’re hearing about a plan to make evidence about health central to all aspects of government.

Laura Webber, director of public health modelling at the UK Health Forum, Susie Morrow, chair of the Wandsworth Living Streets Group and Brian Ferguson, chief economist at Public Health England join us to discuss a “health in all policies” approach, with protected funding for preventive interventions.

Read their full analysis: https://www.bmj.com/content/362/bmj.k3377

If you’re of a scientific persuasion, watching policy debates around Brexit, or climate change, or drug prohibition are likely to cause feelings of intense frustration about the dearth of evidence in those discussions.

In this podcast we're joined by Chris Bonell, professor of public health sociology - in this podcast he airs those frustrations, and worries that the rise of populism is pushing evidence even further out of policy decision.

Read the accompanying essay: https://www.bmj.com/content/362/bmj.k3827

More than ½ of patients leave hospital with changes to four or more of their long-term medications - but how appropriate are those changes?

New research published on bmj.com looks at antihypertensive medication prescription changes to try and model that - and found that more than half of intensifications occurred in patients with previously well controlled outpatient blood pressure.

To discuss what they found, we're joined by Timothy Anderson, primary care research fellow, and Michael Steinman, professor of medicine, both from UCSF.

Read the open access research: https://www.bmj.com/content/362/bmj.k3503

We at The BMJ care about food, and if our listener stats are to be believed, so do you.

In this podcast we’re looking at quality as an important driver of a good diet. At our recent food conference - Food For Thought - hosted in Zurich by Swiss Re we brought researchers in many fields of nutritional science together. We asked people with competing ideas to write articles to elucidate where there’s agreement, and where there is still contention. There was lots of disagreement - but one thing that was widely agreed on was that, quality of food matters. Quality is as, if not more, important than quantity.

In this podcast we’ll be exploring what quality is, how industrial food production affects it, and how we conceptualise quality. Joining us are Martin White, Mathilde Touvier, Jean Adams, Nicola Guess and Alan Levinovitz.

For the last podcast in the food series: https://soundcloud.com/bmjpodcasts/nutritional-science-why-studying-what-we-eat-is-so-difficult?

For more on the Food for Thought series https://www.bmj.com/food-for-thought

The concept of overdiagnosis is pretty hard to get - especially if you’ve been educated in a paradigm where medicine has the answers, and it’s only every a positive intervention in someone’s life - the journey to understanding the flip side - that sometimes medicine can harm often takes what Stacey Carter director of Research for Social Change at Wollongong university described in an preventing overdiagnosis podcast last year as a “moral shock” - https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation

This year, we asked some of the leaders in the field to describe what it was that opened their eyes to overdiagnosis and overtreatment - and recorded the session for you.

You’ll hear from Fiona Godlee, editor in Chief of The BMJ, Steve Woloshin and Lisa Schwartz, directors of the Center for Medicine and Media at The Dartmouth Institute, John Brodersen - professor of general practice at the University of Copenhagen, and Barry Kramer - director of the Division of Cancer Prevention at the U.S. National cancer institute.

The

This week saw the latest Preventing Overdiagnosis conference - this time in Copenhagen.

The conference is a is a forum where researchers and practitioners can present examples of overdiagnosis - and we heard about the various ways which disease definitions are being subtly widened, and diagnostic thresholds lowered.

In this podcast we talk to Allen Frances, psychiatrist and former chair of the Diagnostic and Statistical Manual of Mental Disorders. We also hear from friends of the podcast, Steve Woloshin and Lisa Schwartz about the way in which some disease awareness campaigns fuel inappropriate diagnosis.

https://www.preventingoverdiagnosis.net/ https://www.bmj.com/too-much-medicine

The number of people estimated to be latently infected with TB - that is infected with TB, which has not yet manifested symptoms - is around 2 billion. That is 1 in 3 people on the planet are infected by the bacteria. The World Health Organization’s website notes that on average 5-10% of those infected with TB will develop active TB.

That number is terrifying, but a new analysis published in the BMJ, suggests that the assumption that latent TB often has a very long incubation period of many years may be wrong - and that may change how we calculate the number of people affected, and our whole approach to tackling the disease.

This podcast features Lalita Ramakrishnan, professor of immunology and infectious diseases at Cambridge University, Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania, and Marcel Behr, professor of medicine at McGill university.

Together they discuss the analysis article "Revisiting the timetable of tuberculosis" - https://www.bmj.com/content/362/bmj.k2738

This week, a very special conversation with a maverick British medico who set up a tiny research centre in Oxford and watched it grow into a global collaboration of over 40,000 people across 130 countries. Three decades on, the Cochrane Collaboration now produces the world's most trusted health evidence that's used by patients, health professionals, researchers and policy makers around the world every day.

Cochrane co-founder Iain Chalmers joins Ray to look back on the origins of the organisation and the extraordinary life of its namesake, Archie Cochrane. Iain also reflects on his work beyond the collaboration - from working in refugee camps in Gaza to teaching children in Uganda how to detect ‘bullshit’ health claims and more recently, establishing the James Lind Alliance. It's no surprise he's received the BMJ’s most prestigious award for a lifetime of achievement in healthcare, along with a knighthood from the Queen.

Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women. It is an important and neglected area of female health, associated with substantial morbidity and distress.

Women may be seen by several clinicians before a diagnosis is reached, There are also specialist psychosexual clinics, where men and women can be referred for sexual problems. Little has been written on the holistic approach to care for women with dyspareunia, therefore, some of the advice here is based on expert experience.

Joining us to talk about care are Leila Frodsham, consultant gynaecologist and lead for psychosexual medicine, and Nikki Lee, speciality trainee in obstetrics & gynaecology, both at King’s College London. We’re also joined by Poppy, who experienced dyspareunia and has undergone treatment.

Read the full education article: https://www.bmj.com/content/361/bmj.k2341

Sue Farrington is chair of the Patient Information Forum, a member organisation which promotes best practice in anyone who produces information for patients.

In this podcast, she discusses what makes good patient information, why doctors should be pleased when patients arrive at an appointment with a long list of questions, and why patients are savvy about believing "doctor google".

https://www.pifonline.org.uk/

Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance - but the professions are using different methods to combat resistance and reduce overuse.

In this roundtable, we bring medics and vets together to discuss the problem - where antibiotic resistance arises, how resistance genes propagate through the environment and between countries, and what non-drug approaches can be used to reduce the need for antibiotics.

Sandy Trees, Vet Record editor in chief, and retired veterinary surgeon Stuart Reid, principal of the Royal Veterinary College Jenny Bellini, cattle and dairy vet, Friars Moor Livestock Health in Dorset Peter Hawkey, professor of clinical and public health bacteriology, University of Birmingham Tim McHugh, professor of medical microbiology at University College London Emmanuel Wey, consultant in infection, Royal Free Hospital, London

It’s been quite a year for the NHS - it just turned 70, had a winter crisis like never before, got over junior doctor strikes, but then was hit by a series of scandals about breast screening, and now opiate prescriptions.

At the same time, we’ve seen demonstrations in favour of the service and even widespread public backing for more money. So how do all of these things mix into the way in which the British public view the NHS?

In this podcast, Ben Page - chief exec of Ipsos MORI, the polling company, joins us to discuss the fluctuations in public opinion.

Read the provocation: https://www.bmj.com/content/361/bmj.k2663

More NHS at 70 coverage: https://www.bmj.com/nhs-at-70

Ray Moynihan is a senior research assistant at Bond University, a journalist, champion of rolling back too much medicine, and host of a new series “The Recommended Dose” from Cochrane Australia.

In the series, Ray has talked to some of the people who shape the medical evidence that underpin healthcare around the world - the series aim is to elucidating their worldview, and how their thinking shapes their work.

Over the next couple of months, we’ll be co-publishing the series - so keep an ear out for those interviews in your podcast feed.

At evidence live this year, one of the sessions was about the work of Evidence Aid - and their attempt to bring high quality evidence to the frontline of a humanitarian crisis.

In that situation, it’s very difficult to know what will work - a conflict, or even immediately post-conflict situation is characterised by chaos - and merely doing something is vital. But though each situation is unique, sharing what’s worked elsewhere can be key to maximising the help given to vulnerable people.

At Evidence Live this year, the focus of the conference was on communication of evidence - both academically, and to the public. And part of that is the role that investigative journalism has to play in that.

At the BMJ we’ve used investigative journalistic techniques to try and expose wrong doing on the part of government and industry - always in collaboration with clinicians and researchers.

To explain a bit more about the world of journalism and campaigning, we're joined by to Shelley Jofre - from the BBC, Jet Schouten - from Radar, Kath Sansom - who started the online sling the mesh campaign & Deb Cohen, former investigations editor at The BMJ.

When tackling societal problems - like the opioid epidemic in the US - there are two ways of approaching it. One is to reduce demand - by organising treatment programmes, or reducing the underlying reasons why people may become addicted in the first place - but that’s hard. So governments often turn to the other route - reducing supply - and that’s what the US government did in 2014 when it rescheduled oxycodone combination products from schedule 3 to schedual 2 - essentially making it harder for people to obtain a prescription.

Now reducing that legal supply, without in hand reducing the demand, led to fears that those people with an opioid addiction would just turn to illicit routes to obtain their drugs - and new research published on bmj.com has attempted to find out if that happened.

We're joined by 3 of the authors, James Martin, associate professor of criminology at Swinburne University; Judith Aldridge, professor of criminology at the University of Manchester; and Jack Cunliffe, lecturer in quantitative methods and criminology at the University of Kent.

Read the full research: https://www.bmj.com/content/361/bmj.k2480

There’s a lot going on in the world at the moment - Ebola’s back, Puerto Rico is without power and the official estimations of death following the hurricane are being challenged. The WHO’s just met to decide what to do about it all, as well as sorting out universal healthcare, access to medicines, eradicating polio, etc etc.

To make sense of that a little, we grabbed Ashish Jha - Director of the Harvard Global Health Institute to shed some light into how decisions about global health are made, and why he tries to see the world as it actually is - not how he wishes it would be.

Reading list: Mortality in Puerto Rico after Hurricane Maria https://www.nejm.org/doi/full/10.1056/NEJMsa1803972

https://www.bmj.com/universal-health-coverage

Each time you order a test for a child, do you think the population that makes up the baseline against which the results are measured? It turns out that that historically those reference intervals have been based on adults - but children, especially neonates and adolescents, are undergoing physiological changes that mean those reference intervals may not be appropriate.

To get around this Khosrow Adeli, head and professor of clinical biochemistry at the Hospital for Sick Children, and the University of Toronto, and colleagues have undertaken a mission to recruit children and young people into a study of their test results.

Read the full practice article: https://www.bmj.com/content/361/bmj.k1950

Patients who are depressed and prescribed antidepressants may report weight gain, but there has been limited research into the association between the two. However new observational research published on bmj.com aims to identify that association.

Rafael Gafoor, a psychiatrist and researcher at Kings College London, and one of the authors of that research joins us to talk about the potential mechanism of action - is it a physiological response to the drug, is it to do with the underlying reason for the prescription; how they studied the association; and what this might mean for individual prescriptions.

You can read the full research on bmj.com; https://www.bmj.com/content/361/bmj.k1951

There’s been a lot of attention given to the new antirviral drugs which target Hepatitis C - partly because of the burden of infection of the disease, and the lack of a treatment that can be made easily accessible to around the world, and partly because of the incredible cost of a course of treatment.

But a new article on BMJ talks about the uncertainly of that treatment - do we know that the drugs actually clear a HepC infection, and that this will lead to a corresponding decrease in mortality and morbidity?

Janus Jakobsen from the Copenhagen Clinical Trial Unit joins us to discuss what the literature proves.

Read the full article: https://www.bmj.com/content/361/bmj.k1382

We’re in an era of big data - and hospitals and GPs are generating an inordinate amount of it that has potential to improve everyone’s health. But only if it’s used properly. New research published on www.bmj.com this week describes another set of information, about that data, that the authors believe could be just as important as the data itself.

Griffin weber, and Isaac Kohane, from the Department of Biomedical informatics at Harvard medical school join us to discuss.

Read the full research: https://www.bmj.com/content/361/bmj.k1479

We talk about financial conflicts of interest a lot atThe BMJ - and have take taken the decision that our educational content should be without them.

We also talk a lot about non-financial conflicts of interest, but the choppy waters of those are much more difficult to navigate.

In this podcast, we discuss whether we should, or if we could even could, make people’s intellectual positions transparent.

Arguing that it’s important to tackle this issue, are Wendy Lipworth and Ian Kerridge from Sydney health Ethics at the University of Sydney - and arguing that it’s not as easy as we think is Marc Rodwin, from Suffolk University Law School in Boston.

Read the full head to head: https://www.bmj.com/content/361/bmj.k1240

In 2016, from an estimated pre-war population of 22 million, the United Nations (UN) identified 13.5 million Syrians requiring humanitarian assistance, of which more than 6 million are internally displaced within Syria, and around 5 million are refugees outside of Syria.

In this podcast, Aula Abarra, consultant in infectious disease from London, joins us to discuss what's happening now in Eastern Ghouta, and area of Damascus, where civilians are being held under siege, where humanitarian aid is unable to reach.

Read the full editorial: https://www.bmj.com/content/360/bmj.k1368

Ravi Gupta, is a resident in internal medicine at Johns Hopkins in Baltimore - and as he said has seen the influence of sudden price hikes on his patients - between 2010 and 2015 more than 300 drugs in the U.S. have seen sudden increases of over %100.

Ravi and his co-authors have suggested, and tested the feasibility of, a possible answer to those price hikes - a small tweak that should protect patients from the possibility that they’ll suddenly be unable to afford their essential medication.

Read the full research: http://www.bmj.com/content/360/bmj.k831

That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour.

In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen around a hospital, what needs to be done to set up an environment that allows the victims of unprofessional behaviour to speak out about senior members of staff, and how she goes about confronting perpetrators about their behaviour.

Read the full editorial: http://www.bmj.com/content/360/bmj.k1025

Its now widely agreed that one of the key ways of reducing the current high level of "waste " in biomedical research is to focus it more squarely on addressing the questions that matter to patients - and the people and medical staff that care for them.

In this interview, Tessa Richards - the BMJ's patient partnership editor, talks to Katherine Cowan, independent consultant and a senior advisor the the James Lind Alliance, which has pioneered patient involvement with their research priority setting partnerships.

In this conversation they talk about how these work, the challenge of navigating between different groups with what are often very different views and agendas, and why she thinks healthy debate on divergent views is no bad thing

In a new analysis John McArthur and Krista Rasmussen, from the Global Economy and Development Program at the Brookings Institution, and Gavin Yamey from Duke University, have set out to analyse the potential for lives saved by the goals set in the Sustainable Development Goals

In this conversation I talked to Gavin and John about the numbers, which countries have to accelerate their development to meet those goals - and we also address some of the criticisms of the SDGs - that they’re too wide ranging, that they lack a political dimension, and that they are unrealistic.

Read the full analysis and more on the SDGs: http://www.bmj.com/content/360/bmj.k373 http://www.bmj.com/content/sustainable-development-goals

A study published by The BMJ today reports a possible association between intake of highly processed (“ultra-processed”) food in the diet and cancer.

Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals and reconstituted meat products - often containing high levels of sugar, fat, and salt, but lacking in vitamins and fibre. They are thought to account for up to 50% of total daily energy intake in several developed countries.

Mathilde Touvier, senior researcher in nutritional epidemiology and Bernard Srour, pharmacist and PhD Candidate, both at INSERM, join us to discuss what ultra processed foods actually are, why it is they could be leading to cancer, and what their cohort study tells us about that potential risk.

Read the full open access research: http://www.bmj.com/content/360/bmj.k322

Bobbie Farsides is professor of clinical and biomedical ethics at Brighton and Sussex Medical School. She’s been described as one of the few people that is acceptable to “both sides” of the assisted dying debate.

This week she joins us to talk about the way in which the debate on euthanasia has played out in the UK - and hear why she thinks it’s now time for all individual doctors to make up their own mind, and not let either camp own the argument for them.

Read her commentary on the debate: http://www.bmj.com/content/360/bmj.k544

We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk?

Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a day.

Read the full review: http://www.bmj.com/content/360/bmj.j5855

Virginia Murray, public health consultant in global disaster risk reduction at Public Health England, was instrumental in putting together the Sendai Framework for Disaster Risk Reduction - an international agreement which aims to move the world from reacting to disasters, to proactively preventing them.

In this podcast, she explains what they learned in the process, and why science had to become storytelling, in order to make politicians pay attention.

Read the editorial on creating a set of indicators for disaster preparedness. http://www.bmj.com/content/359/bmj.j5279

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.

In this audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. Kate Addlington, associate editor and trainee psychiatrist is joined by Cat Chatfield, quality editor and GP.

They discuss acute respiratory distress syndrome: http://www.bmj.com/content/359/bmj.j5055

Why it’s important to have early diagnosis of psychotic symptoms, and the evidence for improved outcomes: http://www.bmj.com/content/357/bmj.j4578

And finally, why it’s important to consider hearing-loss on the ward: http://www.bmj.com/content/360/bmj.k21

Trial MVA85A - monkey trials for a booster vaccine for BCG, developed by researchers at Oxford University, is the subject of an investigation published on bmj.com.

Experts warn that today’s investigation is just one example of “a systematic failure” afflicting preclinical research and call for urgent action “to make animal research more fit for purpose as a valuable and reliable forerunner to clinical research in humans.”

The press conference is led by Dr Fiona Godlee, the editor-in-chief of the BMJ, who provides a background to the investigation. The panel members are:

Dr Deborah Cohen, author of the investigation and associate editor at the BMJ, talking about carrying out the investigation and the difficulty to obtain basic information

Professor Paul Garner from the Liverpool School of Tropical Medicine, addressing the ineffectiveness of the current TB vaccine and also talking about the backlash he experienced after publishing a systematic review concluding that the animal studies results had been overstated

Malcolm Macleod, from the University of Edinburgh, talking about the broader public health aspect

Merel Ritskes-Hoitinga from the Department for Health Evidence in The Netherlands, addressing the quality of animal studies and the need for systematic reviews

and Jonathan Kimmelman, from McGill University in Canada analysing the story from the perspective of biomedical ethics.

Neoadjuvant chemotherapy for breast cancer is a new strategy that was introduced towards the end of the 20th century with the aim of reducing tumour size - rendering an otherwise inoperable tumour operable, allowing more conservative surgery, and hopefully improving overall survival.

Although data indicate that the first rationale remains valid, the others have not led to the desired outcomes. More conservative surgery after neoadjuvant chemotherapy can result in a higher rate of local recurrence, and, despite the earlier initiation of systemic treatment, no improvement in survival has been seen.

Jayant Vaidya, professor of surgery and oncology and consultant breast cancer surgeon at University College London, joins us to explain why he is rethinking the use of neoadjuvant chemotherapy for breast cancer.

Read the full analysis: http://www.bmj.com/content/360/bmj.j5913

Winter pressures on NHS services have kicked in a little bit earlier than usual. So here to discuss that, and also the issue of how local NHS leaders can support staff in times of extreme pressure.

Discussing that with Rebecca Coombes, The BMJ’s head of news and views, are Matthew Inada-Kim, a consultant in acute and general medicine at Hampshire Hospitals NHS Foundation Trust, and Joe Harrison, CEO of Milton Keynes Hospital NHS Foundation Trust.

Acute respiratory distress syndrome was first described in 1967 and has become a defining condition in critical care. Around 40% of patients with ARDS will die, and survivors experience long term sequelae. No drug treatments exist for ARDS, however good supportive management reduces harm and improves outcome.

In this podcast, John Laffey, professor of anaesthesiology at St Michael’s Hospital, Toronto and Brian Kavanagh, clinician-scientist, intensive care medicine at the University of Toronto take us through the background to diagnosis and treatment of ARDS.

Cheryl Misak, professor of philosophy at the University of Toronto, and survivor of ARDS, also joins us to explain how she has faired in recovery.

Read the full easily missed article: http://www.bmj.com/content/359/bmj.j5055

Average body temperature is 37°C, right?

That was the conclusion of Carl Wunderlich in his magnum opus, The Course of Temperature in Diseases - Wunderlich published that in 1868, following his extensive collection of body temperature readings - and 37°C stuck. But, it’s not as simple as that

Philip Mackowiak, emeritus professor of medicine, and now history of medicine scholar in residence, at the University of Maryland School of Medicine, has been interested in temperature for a long time. He joins us to explain how Wunderlich measured temperature, and what he actually found.

Read his editorial: http://www.bmj.com/content/359/bmj.j5697

Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk.

In this podcast we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people.

In a linked podcast, we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder.

Read the articles: http://www.bmj.com/content/359/bmj.j5328 http://www.bmj.com/content/359/bmj.j5378 http://www.bmj.com/content/359/bmj.j5245

As journal editors, we’re aware of the fact that we have a role to play in scientific discourse - that’s why The BMJ has been so keen to talk about the way in which scientific knowledge is constructed, through our Evidence Manifesto.

We also know that money has influence in the scientific literature - which is why we have a zero tolerance policy for financial conflicts of interest in our educational content.

Where do journal editors fit into this?

The first step into investigating that is to find out if journal editors receive payments from pharma and device companies - and new research, published on bmj.com does that.

Jessica Liu - internist and assistant professor at the university of Toronto, and one of the authors of that study joins us to discuss.

Read the full research: http://www.bmj.com/content/359/bmj.j4619

If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation.

The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as a cost saving measure.

Now new research published on bmj.com looks at these phone consultation - how often they happen, how patients feel about them, and how much money they actually save.

In this podcast we're joined by Martin Roland, emeritus professor of health services research at Cambridge University, to find out more.

Read the full research: http://www.bmj.com/content/358/bmj.j4197

Should we welcome plans to sell off NHS land?

The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking.

Read the Head To Head article: https://www.bmj.com/content/358/bmj.j4290

In the UK - type 2 diabetes now affects between 5-10% of the population - and accounts for around 10% of our total NHS budget. For the individuals affected, treatments are effective at helping control glucose levels - however, the sequela associated with the disease - vascular problems, and a life expectancy that’s 6 years shorter - are still an issue.

However, for some, remission seems to be a possibility.

To discuss we're joined by Mike Lean, professor of human nutrition at the university if Glasgow, and co-author of an analysis, published on bmj.com, which impels doctors to make sure that type to diabetes remission is coded properly.

Read the full analysis: http://www.bmj.com/content/358/bmj.j4030

One of the hurdles that anyone who submits research or analysis to The BMJ has to deal with is peer review.

The problems of the process, and some of the potential solutions, was a big part of the Peer Review Congress which took place last week.

In this interview, Sophie Cook, The BMJ's UK research editor, talks to Lisa Bero, who’s a professor of evidence based medicine at Sydney University, and spends a lot of time investigating the integrity of health research.

A new Rapid Recommendation from The BMJ suggests that for pregnant women, they may wish to avoid certain antiviral treatments for HIV.

This recommendation differs from the WHO's, and to discuss why that is, and what makes that difference important, we're joined by Reed Siemieniuk, a physician and methodologist from McMaster University, and Alice Welbourn, campaigner for gender and sexual and reproductive health rights, in the context of HIV and violence against women.

Read the full rapid recommendation: http://www.bmj.com/content/358/bmj.j3961

And Alice Welborn's opinion article: http://blogs.bmj.com/bmj/2017/09/11/alice-welbourn-who-and-the-rights-of-women-living-with-hiv/

If you google "The NHS" you'll see screaming headlines from the Daily Mail about cost and waste - debate in parliament is about how much of our GDP we should be spending - and each year, hospital trusts go cap in hand to ask for more funding.

Against this backdrop, a new analysis, and a first in a series, published on bmj.com, looks at what it takes to have sustainable healthcare - and cruically, talks about this from the point of view of benefit, not cost.

I'm Duncan Jarvies, and I'm Navjoyt Ladher, and today we've come to the House of Lords to speak to Baron Nigel Crisp - cross-bench peer, former NHS trust executive, and health system guru.

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.

A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;

Why the World Bank matters to global health The World Bank’s turn to Universal health coverage How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are The Global Financing Facility - grants and loans supplied together, and finally, creating a market out of pandemic risk

In this fourth interview, Genevie Fernandes a PhD student at the University of Edinburgh discusses a new model of combing grants and loans in the Global Financing Facility.

Read the full analysis: http://www.bmj.com/content/358/bmj.j3395

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.

A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;

Why the World Bank matters to global health The World Bank’s turn to Universal health coverage How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are The Global Financing Facility - grants and loans supplied together, and finally, creating a market out of pandemic risk

In this third interview, Janelle Winters a PhD student at the University of Edinburgh explains what the bank's trust funds are, and why it can be hard to tell what they're funding.

Read the full analysis: http://www.bmj.com/content/358/bmj.j3394

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.

A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;

Why the World Bank matters to global health The World Bank’s turn to Universal health coverage How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are The Global Financing Facility - grants and loans supplied together, and finally, creating a market out of pandemic risk

In this first interview, Devi Sridhar, professor of global health at the University of Edinburgh explains why the bank matters for global health.

Read the full analysis: http://www.bmj.com/content/358/bmj.j3339

This week we’re at the over diagnosis conference in Quebec Canada, Preventing overdiangosis is a forum to discuss the harms associated with using uncertain methods to look for disease in apparently healthy people - and is part of the BMJ’s too much medicine campaign.

One of the ways in which the public’s attitudes and wishes around health is measured are citizen or community juries - set up in a similar way to a criminal jury - with an information gathering, and a deliberation phase - recently one of these citizen juries discussed, whether abortion should be allowed in Ireland (they decided “yes”).

We're joined by Rae Thomas, from Bond University and Chris Degeling, from the University of Sydney, who have both been using citizen juries to look at over diagnosis.

In this interview from Preventing Overdiagnosis 2017 (preventingoverdiagnosis.net) Stacy Carter, associate professor at Sydney Health Ethics - and the author of a recently written BMJ essay the ethical aspects of overdiagnosis, joins us to talk about how the cultural context of medicine seeps into our decision making processes and affects how people conceptualise the risks of too much medicine.

Read Stacy's full essay: http://www.bmj.com/content/358/bmj.j3872

Loss of a loved one can be very painful. When seeking support, some people turn to their doctor. Because of their pivotal role in the community, physicians can provide excellent support for bereaved people and can often direct them to additional resources.

Katherine Shear, a physician, and Stephanie Muldberg, a bereaved mother, join us to discuss how grief can play out in the consultation, and explain the importance of doctors acknowledging the death of a patient's loved one.

Read their full practice article: http://www.bmj.com/content/358/bmj.j2854

Mike Richards is well known in the UK - former Cancer Tzar, he now heads up the Care Quality Commission - regulator of all health and social care services, and therefore the body responsible for inspecting hospitals and GP practices.

In this interview, BMJ’s head of news and views, Rebecca Coombes went to the CQC’s headquarters in London, and spoke to Mike Richards - who defends the record of hospital inspection on his watch.

This is an edited version of the interview - read the full write up: http://www.bmj.com/content/358/bmj.j3567

The Alzheimer’s society, in the UK, predicts that if the rates of dementia remain constant there’ll be 1.7 million people in the country living with the condition by 2050. We also know that things like improvements in cardiovascular health are changing those rates.

New research published on bmj.com attempts to model what the outcomes of those changing factors might be, and Sara Ahmadi - Abhari, a research associate in the Department of Epidemiology and Public Health at the University College London, joins us to discuss that model.

Read the open access research: http://www.bmj.com/content/358/bmj.j2856

"Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal. As the volume of clinical research activity has grown the quality of evidence has often worsened, which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.”

Evidence is in crisis, and Carl Heneghan, director for the Centre for Evidence Based Medicine, and Fiona Godlee, editor in chief of The BMJ set out the 9 points of the Evidence manifesto, which tries to set a road map for strengthening the evidence base.

1) Expand the role of patients, health professionals and policy makers in research 2) Increase the systematic use of existing evidence 3) Make research evidence relevant, replicable and accessible to end users. 4) Reduce questionable research practices, bias, and conflicts of interests 5) Ensure drug and device regulation is robust, transparent and independent 6) Produce better usable clinical guidelines. 7) Support innovation, quality improvement, and safety through the better use of real world data. 8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices. 9) Encourage the next generation of leaders in evidence-based medicine.

http://www.bmj.com/content/357/bmj.j2973

The 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals, national health systems remained weak and were unable to cope with the epidemic.

Margaret Kruk associate professor of global health at the Harvard TH Chan School of Public Health, joins us to discuss what makes a health system resilient, and how Liberia in particular has learned lessons from Ebola.

Read the full analysis: http://www.bmj.com/content/357/bmj.j2323

The rapid changes in the global environment have led many scientists to conclude that we are living in a new geological epoch—the Anthropocene—in which human activities have become the dominant driving force transforming the Earth’s natural systems.

A recent joint publication by the World Health Organization and Convention on Biological Diversity articulated the myriad connections between biodiversity and health and the threats to both posed by environmental change.

Andy Haines, professor of public health and primary care, at the London School of Hygiene and Tropical Medicine joins us to talk about a new research platforms present an opportunity to advance understanding of how to safeguard health in the face of global environmental change.

Read more: http://www.bmj.com/content/357/bmj.j2358

We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them?

In this third discussion we went to Scotland, to find out what the people who create policy think about the issues with evidence synthesis, and how the information they create is being used in practice.

evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support.

In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods.

In this podcast, Natalie Joseph-Williams from Cardiff University and Richard Thomson from Newcastle University, join us to discuss how the project went, and what key lessons they learned from the pilot.

Read their full analysis: http://www.bmj.com/content/357/bmj.j1744

For seven years, Republicans have vowed to repeal the Affordable Healthcare Act (Obamacare), and that promise took a central place in President Trump's campaign. The first major vote to replace it was due to happen last week, but was cancelled at the 11th hour.

In advance of the potential vote, The BMJ published a debate asking "Should US doctors mourn for Obamacare?". Now we're asking the authors of that debate, what next?

Joining Peter Doshi are Adam Gaffney, from Harvard Medical School and Saurabh Jha from the Hospital of the University of Pennsylvania.

Read their original debate: http://www.bmj.com/content/356/bmj.j1441

The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding.

In this week's round up we're discussing:

The offer of an HIV screen for an asymptomatic adult http://www.bmj.com/content/356/bmj.i6656

Two articles on legal highs Novel psychoactive substances: types, mechanisms of action, and effects http://www.bmj.com/content/356/bmj.i6848 Novel psychoactive substances: identifying and managing acute and chronic harmful use http://www.bmj.com/content/356/bmj.i6814

and how to become better at supporting relatives and carers at the end of a patient’s life http://www.bmj.com/content/356/bmj.j367

Viral exanthema can cause rash in a pregnant woman and should be considered even in countries that have comprehensive vaccination programmes. Measles and rubella can cause intrauterine death. Intrauterine infection with rubella can lead to congenital rubella syndrome in the liveborn baby.

In this podcast, Jack Carruthers, honorary clinical research fellow at Imperial College London joins us to discuss spotting a viral rash, what steps to take to assess cause, and what advice to give a worried parent.

Read the full clinical review: http://www.bmj.com/content/356/bmj.j512

The UK government published its report Childhood Obesity: a Plan for Action, in August 2016. A new analysis article takes them to task for the inadequacy of that response to a growing problem.

Neena Modi is a professor of neonatal medicine, at Imperial College London, and president of the Royal College of Paediatrics and Child Health, and joins us to discuss what that report should have contained.

Read the full analysis: http://www.bmj.com/content/356/bmj.j762

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals.

Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement. Over half of NHS complaints concern care of the dying.

In this podcast, Katherine Sleeman, clinician scientist and honorary consultant in palliative medicine at King's College London, and Jane Harris, counselling and psychotherapy practitioner, and bereaved mother and daughter join us to discuss what support the carers and relatives of a dying patient need, and give practical advice on how to become better at having those difficult conversations.

Read the full essentials article: http://www.bmj.com/content/356/bmj.j367

Evidence shows using electronic health records can increase efficiency, and reduce preventable medical errors - but only if they are used properly. However, in the US, the president of the American Medical Association calls them almost unusable.

In this debate, Richard Hurley is joined by George Gellert, Regional Medical Informatics Officer at CHRISTUS Santa Rosa Health System and Edward Melnick, Assistant Professor of Emergency Medicine at Yale, who debate whether US doctors should be using electronic medical records.

Read the related article: http://www.bmj.com/content/356/bmj.j242.

Surrogate endpoints are commonly used in clinical trials to get quicker results, however Michael Baum, emeritus professor at University College London, worries that by not focusing on real outcomes - length of life, and quality of life - that these are being used to justify expensive treatments which may not benefit patients.

Read the full analysis: http://www.bmj.com/content/355/bmj.i6286

In an ideal world, policies would be evidence based - but governments are made of humans, who have positions and ideologies and moral bases.

In this podcast Anthony Painter, from the RSA will be talking about why universal basic income may work, but who’s proponents cross ideological barriers, and writer and philosopher AC Grayling explains how economic arguments become moral crusades.

A universal basic income: the answer to poverty, insecurity, and health inequality? http://www.bmj.com/content/355/bmj.i6473

Morality and non-medical drug use http://www.bmj.com/content/355/bmj.i5850

Allocation concealment - blinding which arm of a trial a patient is randomised to - is being questioned in an analysis published on thebmj.com.

David Torgerson, director of the York Trials Unit at the university of York and colleagues have been looking at the way in which trials do this randomisation, and how they subsequently report it - and have found both lacking.

Read the full analysis: http://www.bmj.com/content/355/bmj.i5663

In the UK, junk food advertising is banned on children’s TV - but manufactures are still able to target children in other ways. A recent report from the WHO "Tackling food marketing to children in a digital world", takes a look at the issue.

In this podcast we're joined by João Breda, programme manager for nutrition physical activity and obesity at the regional office for Europe of the World Health Organisation, and Mimi Tatlow-Golden, lecturer in childhood studies and developmental psychology at the open university, and the lead author on the report.

Read the full report: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2016/tackling-food-marketing-to-children-in-a-digital-world-trans-disciplinary-perspectives-2016

Lily was diagnosed at 14 years old with stage four Hodgkin's lymphoma and received six rounds of chemotherapy and two weeks of radiotherapy. She survived but now lives with the long term effects of that therapy - and joins us to discuss how it has impacted her quality of life.

We're also joined by Saif Ahmad and Thankamma Ajithkumar, oncologists from Cambridge University Hospitals NHS Foundation Trust, who give advice for generalists on late effects of anticancer chemotherapy that may affect quality of life.

Read the full clinical review: http://www.bmj.com/content/354/bmj.i4567

"I say to all Australian doctors - young, old, the political and the apolitical - that on this depends not just our ethical credibility as a profession, but our shared humanity. "

Following the leaked emails published in The Guardian newspaper, alleging abuse of asylum seekers detained by the Australian government on the Pacific island of Nauru, David Berger joins us again to say it is time that doctors take a stand and march to protest against this treatment.

Read his full editorial: http://www.bmj.com/content/354/bmj.i4606

Listen to the head to head debating if doctors should boycott working at the detention centres: https://soundcloud.com/bmjpodcasts/should-doctors-boycott-working-in-australias-immigration-detention-centres

The European Medicines Agency (EMA) has embraced a new model of drug testing and marketing called “adaptive pathways”, allowing new drugs for “unmet medical needs” to be launched on the market faster, on the basis of fewer data.

While industry claims this is necessary, an analysis on thebmj.com looks at the assumptions underlying the new pathway, and raises concerns about the negative impact on patient safety and the cost of healthcare.

To discuss, we're joined by Courtney Davis, senior lecturer at King’s College London, Peter Gøtzsche, director of the Nordic Cochrane Centre and Joel Lexchin, a professor at York University in Toronto.

Read the full analysis: http://www.bmj.com/content/354/bmj.i4437

Andrew Elder, a professor at the University of Edinburgh talks about likelihood ratios in diagnostic testing, and how they’re helpful in thinking about how context changes the predictive value of a test.

This is part of a wider discussion on the evidence behind clinical examination of the cardiovascular system https://soundcloud.com/bmjpodcasts/evidence-for-examination

Read the full clinical review: http://www.bmj.com/content/354/bmj.i3309

We’re taught that patients' ideas, concerns, and expectations are central to a successful consultation, but has ICEing gone too far?

A “What your patient is thinking” article published this week talks about the pressure that asking questions in the wrong way can put on a patient.

Sophie Cook, education editor for The BMJ, is joined by the author of that article - The BMJ’s patient editor, Rosamund Snow, and by Roger Neighbour, former president of the royal college of general practice, and author of "The Inner Consultation".

http://www.bmj.com/content/354/bmj.i3729

2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.

Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Aresti, a specialist registrar in trauma and orthopaedic surgery and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com

In a linked podcast, Nick Nicholas, a patient who has hip OA gives us his perspective.

Read the full article: http://www.bmj.com/content/354/bmj.i3405

Listen to the linked podcast: https://soundcloud.com/bmjpodcasts/having-hip-osteoarthritis

The same piece of evidence may reach you via a journalist, or via your doctor - but the way in which that evidence is communicated is changed by your relationship between that person.

Julia Beluz from Vox and Victor Montori from the Mayo Clinic join us to discuss if it's possible to reconcile those competing points of view.

Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. A clinical update explains why successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the end of life.

Kate Adlington, clinical editor at The BMJ, is joined by the authors of the paper - Christian Hosker, consultant liaison psychiatrist at Leeds and York Partnership Foundation Trust, and Michael Bennett, professor of palliative medicine at the University of Leeds.

http://www.bmj.com/content/353/bmj.i3085

Global evidence indicates that mandated treatment of drug dependence conflicts with drug users’ human rights and is not effective in treating addiction.

Karsten Lunze, associate professor at the Boston University School of Medicine, joins us to describe the evidence, and why he is convinced seemingly counter intuitive hard reduction works.

http://www.bmj.com/content/353/bmj.i2943

How can asking patient to tell us their story improve healthcare? Helen Morant, content lead at BMJ, talks us through her project getting healthcare professionals to sit down with patients and record their conversations, and what on earth this has to do with quality improvement.

We also hear some of the recordings she has gathered through the project.

Here are links to the other podcasts and projects Helen mentions:

Story Corps - https://storycorps.org/

The Listening Project - http://goo.gl/3auSHX

Beautiful stories from anonymous people - http://goo.gl/78QSjU

Interviews from the Women deliver conference in Copenhagen.

Donna McCarraher, director of reproductive, maternal, newborn and child health at FHI 360, explains why women should be at the centre of efforts to mitigate the effect of Zika Virus in Brazil.

Katja Iversen, CEO of Women Deliver, joins Rebecca Coombes to explain why the UN sustainable development goals are unachievable if we don't empower women and girls to take control of their health, wellbeing, and reproductive rights.

http://womendeliver.org/

Travellers’ diarrhoea is one of the most common illnesses in people who travel internationally, and depending on destination affects 20-60% of the more than 800 million travellers each year. In most cases the diarrhoea occurs in people who travel to areas with poor food and water hygiene.

Mike Brown, consultant in infectious diseases and tropical medicine at the London School of Hygiene and Tropical Medicine, explains the approach to the prevention and treatment of diarrhoea in travellers.

Read the full review: http://www.bmj.com/content/353/bmj.i1937

Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is.

Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement.

Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016. Watch out for the extended versions of these recordings, up next Friday.

Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don't measure medical error, and why it is so important that we start.

Read the full analysis: http://www.bmj.com/content/353/bmj.i2139

The BMJ recently held a discussion between experts in the fields of general practice, emergency medicine, and paediatrics about the state of out of hours care in the UK, and crucially offered their vision for a better service.

Are children a special case, can urgent care ‘hubs’ be a silver bullet, is NHS 111 up to the job of triaging patients, do there enough clinicians involved in out of hours care, and are other countries doing a better job?

The state of out of hours care can best be described as ‘patchy,’ with some, even most, people receiving good and timely care although from a confusing plethora of different bodies - walk-in centres, urgent care centres, out of hours centres, telephone consultation and - that most recognisable of all NHS brands - Accident and Emergency. But there are also very serious deficiencies attributed to core problems identified by our experts below.

Around the table were: Clifford Mann, president of The Royal College of Emergency Medicine and an emergency medicine consultant in Taunton in Somerset; Neena Modi, professor of Neonatal Medicine in the Imperial College, London and president of Royal College of Paediatrics and Child Health; and Professor Martin Roland, professor of Health Service Research at the University of Cambridge and who has 35 years experience as a GP.

Read the write up:

In February World Health Organization (WHO) declared the microcephaly epidemic in South America an international public health emergency. Today, the US Centers for Disease Control and Prevention, the CDC, has confirmed that it’s is Zika virus which is causing that microcephaly.

The outbreak was originally spotted in Recife, in Brazil, and it’s from there that the authors of this research paper have been carrying out imaging of the skulls of babies born with microcephaly and probable Zika virus infection - to establish patterns of damage in the brain.

We're joined by Maria de Fatima Vasco Aragao, professor of radiology and scientific director of Multimagem Radiology Clinic, Recife. Also, Vanessa Van Der Linden, paediatric neurologist and clinic director of Association for Assistance of Disabled Children Recife.

Read the full research: http://www.bmj.com/content/353/bmj.i1901

Plan, do, study, act cycles, or PDSA cycles, are the basis of many quality improvement projects, they're a model to trial changes and feed the lessons from each test into the next.

Why are they a popular method, and how do you get the best out of them? And what on earth happens when they explode?

Harriet Vickers asks Julie Reed, National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for north west London.

Read all of Julie's paper (for free): http://qualitysafety.bmj.com/content/25/3/147

Check out BMJ Quality: http://quality.bmj.com

However well intentioned, working in detention centres amounts to complicity in torture, says David Berger, a district medical officer in emergency medicine at Broome Hospital in Australia.

However, Steven Miles, chair in bioethics at the University of Minnesota thinks that they play an important role in telling the world about conditions in these camps.

Read the full debate: http://www.bmj.com/content/352/bmj.i1600

Gareth Iacobucci talks to Candace Imison, director of policy at The Nuffield Trust, about the problems facing GPs, and how primary care could be changed.

"5 minutes with... Candace Imison": http://www.bmj.com/content/352/bmj.i1378

“Juliet”, a woman living in London, was diagnosed with a mysterious illness in November 2015, Ian Cropley, a consultant in infectious disease from The Royal Free London NHS Foundation Trust, was there to investigate.

In this podcast, we find out how Zika, once a little known virus causing a rash and fever, has subsequently become a global health emergency. We also discuss how the infection is linked to microcephaly, and what we still need to understand to control the disease.

All Zika virus resources from BMJ are now freely available on www.bmj.com/freezikaresources.

How should health professionals engage with this increasingly popular but unproved practice?

Aubrey Cunnington, a consultant paediatrician from Imperial College London joins us to discuss.

Read the full editorial: http://www.bmj.com/content/352/bmj.i227

Iqbal Malik, consultant cardiologist at Imperial College Healthcare NHS Trust in London, joins Mabel Chew to discuss the role of angioplasty and stenting in patients with stable angina.

Read the full article online: http://www.bmj.com/content/352/bmj.i205

Around half of people aged over 75 meet the diagnostic criteria for chronic kidney disease (CKD), but there is debate about what this means for patients as only a proportion of elderly people with CKD will have clinically important outcomes as a result.

In this podcast, Dr Arif Khwaja argues that for CKD in the elderly, we should focus on patient centered outcomes rather than applying population risks.

Read the full Analysis article: http://www.bmj.com/content/352/bmj.h6559

The claim that cancer screening saves lives is based on fewer deaths due to the target cancer. Vinay Prasad, assistant professor at Oregon Health and Science University, joins us to argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening.

Read the full analysis: http://www.bmj.com/content/352/bmj.h6080

Despite what hollywood says, science has proven that British teeth are actually better than American. Richard Watt, head of the Research Department of Epidemiology and Public Health at UCL explains how they came to that conclusion.

Read the full research: http://www.bmj.com/cgi/doi/10.1136/bmj.h6543

Larger portions of food increase consumption. Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, joins us to discuss how government action to tackle portion size and packaging could help reset our appetites and make us thinner.

Read the full analysis: http://www.bmj.com/content/351/bmj.h5863

When healthy volunteers are scanned as part of a research project, unexpected findings, with uncertain implications, can be thrown up.

Joanna Wardlaw, professor of applied neuroimaging and honorary consultant neuroradiologist at the University of Edinburgh, joins us to discuss how her group deals with these incidental findings, and what volunteers and patients want to happen when they are found.

Read the full analysis: http://www.bmj.com/content/351/bmj.h5190

The current orthodoxy is that home is the best and preferred place of death for most people, but in this podcast, Kristian Pollock a sociologist from Nottingham University questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere.

Read the full analysis: http://www.bmj.com/content/351/bmj.h4855

Around two fifths of the world’s population (those in tropical and subtropical countries), or up to 2.5 billion people, are at risk of dengue infection.

An estimated 50 million infections occur annually worldwide, with 0.5 million of these cases being admitted to hospital for dengue haemorrhagic fever. Approximately 90% of these cases are in children aged less than 5 years. The epidemiology is, however, changing both regionally and globally.

In this podcast, Senanayake A M Kularatne, senior professor of medicine at the University of Peradeniya in Sri Lanka, joins us to discuss which symptoms should make doctors consider a diagnosis of Dengue fever.

Read the full clinical review: http://www.bmj.com/content/351/bmj.h4661

Read the best practice monograph: http://bestpractice.bmj.com/best-practice/monograph/1197.html

Following on from the clinical review "Caring for sex workers", we spoke to the team at Open Doors, a sex worker outreach clinic in east London, run from the Homerton University Hospital NHS Foundation Trust.

Kim Leveret and Anca Doczi join us to give practical advice on reaching out to sex workers, what barriers exist to them accessing care, and how to take a sex worker sexual history.

Listen to the author of the clinical review, Michael Rekart, talk about the infectious disease side of sex worker health in our accompanying podcast: https://soundcloud.com/bmjpodcasts/sex-worker-health

Read the full review: http://www.bmj.com/content/351/bmj.h4011

Practical advice for sex workers and health professionals, including links to Ugly Mugs: http://www.opendoors.nhs.uk/

The historic reasons for high abortion rates in Romania, from the journal of family planning and reproductive healthcare: https://soundcloud.com/bmjpodcasts/romanian-womens-fertility

Hepatic encephalopathy constitutes a spectrum of neuropsychiatric abnormalities, beginning with subtle psychomotor changes and progressing to confusion with asterixis, somnolence, and then coma, arising in patients with impaired liver function.

In this podcast, Tim Cross, a consultant hepatologist from the Royal Liverpool University Hospital, describes how to diagnose and manage the condition.

We're also joined by Ralph Crawford, who suffers from hepatic encephalopathy, to talk about the burden of the disease and the treatment from a patient's perspective.

Read the full review: http://www.bmj.com/content/351/bmj.h4187

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has been examining the treatment of acute GI bleeds in England's NHS.

Two of the authors, Martin Sinclair, consultant surgeon, and Simon McPherson, consultant vascular radiologist, join us to talk about their findings.

Read the full report: http://www.ncepod.org.uk/gih.htm

Read The BMJ news story: http://www.bmj.com/content/351/bmj.h3488

Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. However, comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths.

In this podcast Susan Sherman, a senior lecturer in psychology at Keele University, and Esther Moss, consultant gynaecological oncologist at University Hospitals of Leicester NHS Trust, argue that the upper age limit for cervical screening needs revisiting and call for awareness campaigns to target older as well as younger women.

Read the full analysis: http://www.bmj.com/content/350/bmj.h2729

Martin McShane, medical director of long term conditions at NHS England, questions the validity of the Quality and Outcomes Framework and suggests how it should change in the future.

Read the related article: http://www.bmj.com/content/350/bmj.h2540

The movement to make data from clinical trials widely accessible has achieved enormous success, and it is now time for medical journals to play their part. From 1 July The BMJ will extend its requirements for data sharing to apply to all submitted clinical trials, not just those that test drugs or devices.

The BMJ's Elizabeth Loder explains what this means for authors, and how we expect researchers to make their data available.

Read the full editorial: http://www.bmj.com/content/350/bmj.h2373

The future of health and social care looks certain to be a defining issue in the forthcoming UK general election. Social care has been subject to deep public spending cuts, raising concerns about the sustainability of services in the future. Whoever wins the next election will need to grapple with providing joined up health and social care services in an era of continued austerity.

A recent debate (heathdebate.net) with key spokespeople from across the political spectrum took place this week, and we assembled a panel of experts to discuss how they think the debate went, and the key promises and gaps in the parties plans for the NHS.

Taking part were: Fiona Godlee, editor in chief of The BMJ Jeremy Taylor - chief executive of National Voices Johnny Marshall - director of policy at the NHS Confederation Jane Dacre - president of the Royal College of Physicians Anita Charlesworth - chief economist at the Health Foundation Mark Porter - chair of council at the BMA Nigel Edwards - chief executive of the Nuffield Trust Chris Ham - chief executive of The King's Fund

For more analysis of the election's health promises, read Gareth Iacobucci's Election Watch column: http://www.bmj.com/content/350/bmj.h2165

In the US the licence, or marketing authorisation, for alteplase is limited to 0-3 hours after onset of stroke, but some other countries - including the UK and Australia - have extended the licence to 4.5 hours.

In an analysis article on thebmj.com Brian Alper, vice president of evidence based medicine research and development at Dynamed, and colleagues, interpret the evidence to suggest increased mortality with uncertain benefit for its use beyond three hours.

Read their full analysis: http://www.bmj.com/content/350/bmj.h1075

Katherine Henderson is the clinical lead of the emergency department at St Thomas's hospital in London.

She worries that lack of ward space is having a domino effect throughout A and E and is the cause of increased waiting time for both patients and ambulances.

If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Obioma Ezekobe is a GP in an urgent care centre in Central Middlesex Hospital.

She believes that the public need to be educated about the use of NHS resources, and be taught when it is appropriate to seek care.

If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.

Patrick Keating, a GP from Enfield, is concerned that small practices are under pressure to increase list size, but aren't able to muster resources to meet this increased demand.

If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Bastiaan Bloem, consultant neurologist at Radboud University Nijmegen Medical Centre, Netherlands, discussing his revolutionary approach to patient centred care.

Read more from the summit: http://www.bmj.com/content/350/bmj.h1172

Mark Folman, a GP in Nottinghamshire, is concerned that more and more work, with more and more patients, means less time with those who really need him.

BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.

If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

In our accompanying roundtable discussion,we hear views from a group of patients and clinicians based largely in the UK on the actions required to advance progress towards providing patient centred care.

To extend the conversation we talked to members of the BMJ's international patient advisory panel and other patient advocates - and what follows are short clips of hour long conversations with people in the US, Europe, India, Equador and Uganda.

While the quality of the recordings vary there is no mistaking the passion of these advocates to improve care for fellow patients and the barriers which need to be overcome to make it happen.

Taking part in this discussion in order are: Dominck Frosch,associate professor, University of California Maggie Breslin US designer, researcher and writer Matthew Maleska, designer, Patient Revolution Project Cristin Lind, patient advocate, Rare Diseases Sweden Corine Jansen, cheif listening officer, JoConnect Jonas Gonseth, chief executive, Gaerente en Hospital de Especialidades Guayaquil, Equador Rakhal Gaitonde chair, community advisory board of the National Institute for Research on Tuberculosis Robinah Alambuya, president of the Pan African Network of People with Psychosocial Disabilities, Uganda Daniel Iga Mwesigwa, executive medical director, Mwesigwa Medical Centre, Uganda

Karen Grépin, assistant professor of global health policy at New York University, has been examining the pledges made by the international community to help fight the ebola virus outbreak - was it really too little, too late?

Read her full analysis: http://www.bmj.com/content/350/bmj.h376

Philipe de Souto Barreto argues that, to reduce premature mortality, policies should focus on getting fully inactive people to do a little physical activity rather than strive for the entire population to meet current physical activity recommendations.

Read the full analysis paper: http://www.bmj.com/content/350/bmj.h23

Those who rise to the top in medicine see themselves as hardworking extroverts with a caring nature, suggests an unscientific analysis of the answers given by contributors to BMJ Confidential.

But ask about their pet hates and another, less nurturing, side emerges. We gathered 6 former confidentialists in The BMJ studio to moan over mince pies.

Read Doctors: caring extroverts or self deluded chocoholics?: http://www.bmj.com/content/349/bmj.g7623

Winners of the Darwin Award must eliminate themselves from the gene pool in such an idiotic manner that their action ensures one less idiot will survive.

Ben and Dennis Lendrem, and colleagues, have reviewed the data on winners of the Darwin Award over a 20 year period and they join us to discuss why men are idiots, and why their team is not the only ones to have noticed.

www.bmj.com/content/349/bmj.g7094

One hundred years ago, Pennsylvanian surgeon Evan Kane penned a brief letter to JAMA in which he declared himself a rigorous proponent of the “benefic [sic] effects of the phonograph within the operating room.”

Now David Bosenquet, a surgeon from University Hospital of Wales in Cardiff has written a Christmas editorial about the evidence for the benefit of music to patients.

Read his editorial here: http://www.bmj.com/content/349/bmj.g7436

And share your perfect playlist with us at bmj.com/playlists

The UK’s austerity programme has disproportionately affected children and people with disabilities, says David Taylor-Robinson, a senior clinical lecturer in public health at the University of Liverpool.

He joins us to discuss why the evidence shows the vulnerable are hit hardest by the cuts to public services, despite the UN conventions on human rights giving children and people with disabilities special protection.

Read his full editorial: http://www.bmj.com/content/349/bmj.g7350